The Clinical Application Of Laparoscopic Choledochotomy With Primary Suture For The Treatment Of Choledocholithiasis

The clinical application of laparoscopic choledochotomy withprimary suture for the treatment of choledocholithiasisObjective:To evaluate the value of laparoscopic choledochotomy with primary suture for the treatment of choledocholithiasis.Methods:Retrospectively analyze the clinical data of 129 patients with choledocholithiasis who underwent LCBDE succesfully in the Second Hospital of Jilin University from October 2018 to October2019.According to different treatment plans,the patients were divided into two groups:LCBDE combined with primary biliary tract suture group was the primary biliary tract suture group,while LCBDE combined with T-tube drainage was the T-tube drainage group.There was no significant difference in general information(age,sex,diameter of common bile duct,maximum diameter of calculi,BMI)and basic diseases(hypertension,diabetes,coronary heart disease,cirrhosis,renal insufficiency,history of myocardial infar ction,chronic obstructive pulmonary disease,etc)between the two groups.The intraoperative conditions(operation time,intraoper-ative blood loss),postoperative conditions(postoperative exhaust time,time of abdominal drainage tube removal,postoperative discharge time,hospital costs,gastrointestinal quality of life index,primary laboratory examination after surgery(ALT,AST,TBIL),and complications(postoperative incidence of electrolyte disorders,bile leakage,bleeding,incision infection,abdominal infection)were compared between the two groups.The measurement data was expressed as mean±standard deviation by t test.The enumeration data was expressed as a percentage using theχ~2 test.Test results P<0.05 indicated a statistically significant difference between the two groups.Results:(1)There was no statistically significant difference in operative time between the primary suture group and the T tube drainage group(134.12±38.17min vs.135.68±33.93min),P>0.05;There was no significant difference in intraoperative blood loss between the primary suture group and the T tube drainage group(32.94±5.38ml vs.36.95±11.43ml),P>0.05.(2)Comparison of postoperative general conditions between the two groups:the first postoperative exhaust time(2.91±1.11d vs.3.88±1.58d),the catheter time(5.50±2.67d vs.6.48±2.64d),and the postoperative discharge time(7.53±4.84d vs.10.75±4.52d)of the primary suture group and the T tube drainage group showed statistically significant differences,and P<0.05;Hos-pital costs in the primary suture group were less than those in the T-tube drainage group(35908.85±3361.85 yuan vs.39394.71±3355.38 yuan),and the difference was statistically significant,P<0.05;The gastrointestinal quality of life index of the primary suture group was higher than that of the T tube drainage group(120.62±7.11 vs.104.68±9.57),and the difference was statistically significant,P<0.05;(3)Comparison of major post-operative laboratory examinations between the two groups:there was no statistically significant differ-ence in ALT between the primary suture group and the T tube drain-age group before(36.55±14.14u/L vs 39.35±12.51u/L),1 day after surgery(36.27U/L±9.35 vs 34.60±9.19u/L),3 days after surgery(34.77±8.99U/L vs 32.4±7.17u/L),and 5 days after surgery(28.71±8.50U/L vs 27.80±7.91U/L),P>0.05;There was no significant diffe-rence in preoperatie AST(39.75±7.51U/L vs.39.37±8.51U/L)betw-een the primary suture group and the T tube drainage group,P>0.05;There was no statistically significant difference in AST betwe-en the primary suture group and the T tube drainage group one day after surgery(37.55±4.10u/L vs.36.10±7.64u/L),three days after surgery(32.75±5.66u/L vs.31.81±9.28u/L),and five days after surgery(27.62±5.43u/L vs.27.50±7.82u/L),P>0.05;The preoperative total bilirubin(30.64±17.56umol/L vs.35.69±17.50umol/L)between the primary suture group and the T tube drainage group showed no significant difference,P>0.05;There was a statistically significant difference in total bilirubin between the primary suture group and the T tube drainage group one day after surgery(28.22±9.72umol/L vs.24.09±8.30umol/L)and three days after surgery(22.40±8.78umol/L vs.18.65±7.04umol/L),P<0.05;There’s no significant differenece in total bilirubin(13.90±5.24umol/L vs.14.92±5.51umol/L)5 days after surgery between the primary suture group and the T tube,P>0.05;(4)There was a statistically significant difference in the incid-ence of bile leakage between the primary suture group and the T tube drainage group(14.70%vs.3.16%).P<0.05;There was no significant difference in the incidence of electrolyte disturbance(5.88%vs.15.79%),bleeding(0.0%vs.1.05%),incision infection(2.94%vs.4.21%),abdominal infection(2.94%vs.2.11%),and total complications(26.47%vs.26.32%)between the primary suture group and the T-tube drainage group,P>0.05.Conclusions:1.LCBDE combined with primary biliary suture can shorten the time of catheter insertion and postoperative hospitalization,reduce hospitalization cost,facilitate postoperative gastrointestinal function recovery and accelerate recovery.2.LCBDE combined with primary biliary suture is comparable to T-tube drainage in reducing biliary tract force and accelerating the recovery of liver function.The short-term drainage and yellow reduction effect of primary suture of biliary tract were not as good as that of T tube drainage,but the long-term effect was as good as that of T tube drainage.3.There was no significant difference in the incidence of total complications between LCBDE combined with primary biliary suture and T tube drainage.Although the incidence of bile leakage increased to some extent,it was still within the acceptable range.Moreover,there is no need to carry T tube for a long time after the operation,which avoids the complications related to T tube,reduces the psychological burden of patients,and guarantees the quality of life after the operation.It has certain advantages and feasibility,and is worth promoting.