| Objective: With the improvement of living standards,cholelithiasis has become a very common disease in clinic,which includes gallstones and intrahepatic and extrahepatic bile duct stones,for some patients,there are both extrahepatic bile duct stones and gallstones.Since the concept of "minimally invasive surgery" has been proposed,the surgical treatment of cholelithiasis has also gradually changed from open surgery to laparoscopy.In this study,through the comparative analysis of the clinical curative effect of three kinds of treating cholecystolithiasis with common bile duct calculi surgery,observation intraoperative and postoperative related indicators,to study the clinical curative effect of three surgical methods in the treatment of gallbladder stones with bile duct,thus,to provide the most suitable operation mode and clinical reference for cholecystolithiasis complicated with bile duct stones.Methods: 117 patients with cholecystolithiasis combined with common bile duct in the department of hepatobiliary surgery of the First Affiliated Hospital of Southwest Medical University from January 2014 to January 2017 were enrolled in this study,according to the treatment methods,these patients were divided into three groups,including the research group(n=39),the control group 1(n=39),the control group II(n=39).The patients in the research group were given with duodenal endoscopy combined with laparoscopy,the patientsin the control group 1 were given with traditional open cholecystectomy + bile duct incision + T tube drainage and the patients in the control group II were given with laparoscopic cholecystectomy combined with biliary exploration.The clinical data of three groups of patients,including gender,age,common bile duct the diameter and number of stones,stone diameter were analyzed.Then,the related indicators were also analyzed among the three groups,including the amount of bleeding,operation time,peristalsis anal exhaust time,postoperative feeding time,postoperative bed time,hospitalization time,the rate of residual stones,hospitalization expenses,postoperative pain score and operation the incidence rate of complications.Results: 1.The basic information in three groups: there is no statistical difference in age,gender,bile duct diameter,common bile duct diameter,bile duct stones and other aspects for three groups(P > 0.05).2.Intraoperative indicators: compared with control group I,the amount of bleeding in control group II and the research group was decreased(96.28±9.61 ml VS 85.73±9.85 ml VS 39.93±7.46 ml,P<0.05)and compared with control group II,the amount of bleeding in the research group was also decreased(85.73 ± 9.85 ml VS 39.93 ± 7.46 ml,P < 0.05),compared with the control group I,the operation time was prolonged in the control group II and the research group(229.75 ± 24.37 min VS 160.05 ±23.84 min VS 152.81 ± 17.26 min,P < 0.05).3.Postoperative indicators:compared with the control group I,the intestinal peristalsisanal exhaust time(46.52±7.84 h VS 26.76±6.52 h,P <0.05),eating time(46.82±5.86 h VS32.39±4.53 h,P <0.05),the time in bed(44.39±3.23 h VS 19.83±3.06,P<0.05)and the hospitalization time(14.05±2.67 d VS11.67±2.25 d,P <0.05)were shorten in control group II,compared with the control group I and II,the intestinal peristalsis anal exhaust time(19.69 ± 4.93 h VS 46.52 ± 7.84 h VS26.76±6.52 h,P <0.05),eating time(25.37±6.95 h VS 46.82±5.86 h VS32.39±4.53 h,P <0.05),the time in bed(15.17±2.98 h VS 44.39±3.23 h VS19.83±3.06,P <0.05)and the hospitalization time(8.16±2.48 d VS 14.05±2.67 d VS11.67±2.25 d,P <0.05)were also shorten in the research group,but the cost of hospitalization(3.22±0.51 VS 2.14±0.43 VS 2.07±0.39,P<0.05)was increased in the research group.4.Postoperative pain score and postoperative complication rate: compared with the control group I,the postoperative pain score was decreased in the research group and the control group II(4.82±0.96 VS 4.77±0.91 VS 3.75±0.73,P<0.05).There was no difference in the incidence of postoperative complications among the three groups(10.26% VS 7.69% VS 7.69%,P > 0.05).Conclusions: The duodenoscopy combined with laparoscopy has advantages in treating cholecystolithiasis combined with common bile duct stone,such as less injury,less pain and rapid postoperative recovery.However,the operation time of this operation is longer and the cost of medical treatment is higher,which are the most important factors of restricting the wide application. |
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