The Clinical Application Of LCBDE Primary Suture And The Application Value Of Intraoperative Drainage Tube

Objective: To explore the effect of clinical application of LCBDE primary suture and clinical application of intraoperative drainage tube in LCBDE primary suture,and evaluate its clinical value.Methods: The objective of the study was to analyze the surgical materials of 117 patients with common bile duct stones admitted to the Department of General Surgery,Chizhou Hospital,affiliated to Wannan Medical College from July 2015 to June 2020.All 117 patients successfully underwent laparoscopic common bile duct exploration(LCBDE)and were divided into two groups according to the surgical method.LCBDE+T tube drainage was group A,a total of 40 cases,and the LCBDE+ bile duct primary suture was group B,a total of 77 cases.Among them,group B placed intraoperative drainage tube for group B1(48 cases)and placed no intraoperative drainage tube for group B2(29 cases).The operation time,intraoperative bleeding,first flatulence,postoperative bile leakage and postoperative blood loss between group A and group B were compared and analyzed.A comparative analysis between group B1 and B2 was carried out on the operation time,postoperative hospital stay,hospital expenses,intraoperative bleeding,postoperative catheterization time,average drainage fluid volume 3 days post operation,body temperature 3 days post operation,leukocytes on the first day post operation and bile leakage after surgery.Results: The operation time of group A(162.8±21.9)was significantly longer than that of group B(144.1±39.2)min,P<0.05,the difference was statistically significant;the intraoperative blood loss of group A(35.2±14.3)was slightly more than that of group B(33.8)±21.1)ml,P>0.05,the difference was not statistically significant;the first postoperative time of flatulence in group A(3.6±1.5)was longer than that of group B(2.2±1.1)d,P<0.05,the difference was statistically significant;The postoperative hospital stay of group A(9.1±4.3) was longer than that of group B(5.4±2.2)d,P<0.05,the difference was statistically significant;the hospitalization cost of group A(1.88±0.37)was more than that of group B(1.43±4.2)ten thousand yuan,P<0.05,the difference was statistically significant;Group A had postoperative bile leakage in 5 cases(12.5%),and Group B had postoperative bile leakage in 9 cases(11.7%),P>0.05,the difference was not statistically significant.The operation time of group B1(127.5±33.4)was significantly shorter than that of group B2(150.4±43.9)min,P<0.05,the difference was statistically significant;the intraoperative blood loss in group B1(28.6±24.6)was slightly less than that of group B2(38.1± 20.6)ml,P>0.05,the difference was not statistically significant;group B1 had more intraoperative bile duct wall edema than group B2,P>0.05,the difference was not statistically significant;the number of common bile duct stones was divided into ≥3 and <3 two groups,when the number of stones obtained in the two treatment groups was ≥3,group B1 had more stones than group B2,P>0.05,the difference was not statistically significant;when the number of common bile duct stones was less than 3,group B1 had more stones than group B2,P>0.05,the difference was not statistically significant;the postoperative drainage time of group B1(3.81.3)was shorter than that of group B2(4.82.3)d,P<0.05,the difference was statistically significant;the operation cost of group B1 was(1.45±0.42))slightly more than that of group B2(1.41±0.42)ten thousand yuan,P>0.05,the difference was not statistically significant;postoperative WBC of group B1(8.7±3.1)*10[9]/L was lower than that of group B2(11.0±3.2)*10[9]/L,P<0.05,the difference was statistically significant;the average drainage volume(17.5±18.4)after 3 days in group B1 was significantly less than that of group B2(34.1±23.2)ml,P<0.05,there was a difference of statistical significance;postoperative hospital stay in group B1(5.4±2.0)was slightly shorter than that in group B2(6.0±2.5),P>0.05,the difference was not statistically significant;postoperative body temperature(>37.3C)was observed over three days.Group B1 had more patients with a body temperature of over 37.3 degrees Celsius on day 1 than group B2,P>0.05,the difference was not statistically significant;group B1 had more patients with a body temperature over 37.3C on day 2 than group B2,P>0.05,the difference was not statistically significant;Group B1 had more patients with a body temperature of more than 37.3C on day 3 than group B2,P>0.05,the difference was not statistically significant.There were 7 cases(14.5%)of postoperative biliary leakage in group B1 and 2 cases(6.9%)of postoperative biliary leakage in group B2,P>0.05,the difference was not statistically significant.Conclusion: 1.The primary suture of biliary tract for laparoscopic biliary exploration is safe and effective,and avoids the pain of indwelling T-tube and T-tube-related complications after surgery.2.The placement of a drainage tube during the operation can promptly drain the effusion caused by the use of choledochoscope,improve the surgical field of vision,shorten the operation time,reduce the amount of postoperative abdominal drainage and the time of catheterization,shorten the patient’s hospital stay,and benefit the healing process of the patient.