Applied Research Of Three Opration Methods In The Treatment Of Cholecystolithiasis Combined With Choledocholithiasis

Objective:By retrospectively analyzing and comparing the general background data and the operation related indicators of patients with cholecystolithiasis combined with choledocholithiasis,and reviewing the relevant literatures,the feasibility and limitations of LC+LTCBDE and LC+LCPS are summarized,which provide certain reference basis for clinical work.Methods:Clinical data of patients with cholecystolithiasis combined with choledocholithiasis treated by minimally invasive surgery in hepatobiliary and pancreatic surgery of Minda Hospital of Hubei Minzu University from January 2015 to June 2019 were collected,then conduct the retrospective study.According to the minimally invasive surgery,the patients were classified into three groups:LC+LTCBDE group(12 cases),LC+LCPS group(23 cases)and LC+LCTD group(61 cases).The general background data and the operation related indicators of the three groups were analyzed to explore and summarize the feasibility and limitations of LC+LTCBDE and LC+LCPS.Results:1.General background data:There were no statistically significant differences in gender,age,weight,number of choledocholith,diameter of common bile duct,preoperative blood amylase and preoperative liver function among the three groups by statistical analysis(P>0.05).The diameter of choledocholith in LTCBDE group was significantly smaller than that in LCPS group and LCTD group(P<0.05);The diameter of cystic duct in LTCBDE group was significantly larger than that in LCPS group and LCTD group(P<0.05).2.Intraoperative conditions and postoperative conditions:There was no statistically significant difference in the success rate of operation among the three groups(P>0.05);In terms of intraoperative bleeding volume,the LTCBDE group was significantly smaller than the LCPS group and the LCTD group(P<0.05),while the difference between the LCPS group and the LCTD group was not statistically significant(P>0.05);In terms of operation time,postoperative exhaust defecation time and postoperative hospitalization time,the LTCBDE group was significantly smaller than the LCPS group,and the LCPS group was significantly smaller than the LCTD group,the difference was statistically significant(P<0.05).3.Postoperative complications:There were no statistically significant differences among the three groups in terms of postoperative biliary leakage,acute pancreatitis,stone residue,incision infection and the incidence of overall complications(P>0.05).Conclusion:1.The three minimally invasive methods are safe and effective in the minimally invasive treatment of cholecystolithiasis combined with choledocholithiasis.The three methods are complementary to each other to improve the clinical efficacy.2.LC+LTCBD operation has the advantages of fast recovery,avoiding common bile duct incision and T-tube related complications,but its limitation lies in the requirement of cystic duct diameter,stone size and location.3.LC+LCPS operation has the advantages of promoting nutrient absorption and restoring gastrointestinal function in the early stage,but there are still many complications,and its limitation lies in the requirement of common bile duct diameter and biliary inflammation.