Study On The Feasibility And Safety Of Laparoscopic Common Bile Duct Exploration Under Modified Puncture Approach

Objective: To explore the safety and feasibility of modified puncture hole approach laparoscopic cholecystectomy + common bile duct exploration.Methods: Clinical data of patients undergoing laparoscopic common bile duct exploration in the Affiliated Hospital of Youjiang Medical University for Nationalities from January 2015 to June 2019 were retrospectively analyzed,and patients were screened according to the inclusion criteria.According to whether surgery T tube,divided the patients into a Primary suture of common bile duct group and T tube drainage of common bile duct group,under the premise,according to the patients with the location of the Trocar divided into two groups,namely the improved group and traditional group,respectively,using the improved puncture hole into the road under laparoscopic cholecystectomy + common bile duct exploration technique and traditional puncture hole into the road under laparoscopic cholecystectomy + common bile duct exploration for treatment.Preoperative indicators,intraoperative data,postoperative recovery,complications and follow-up results were compared between the two groups.Results: A total of 211 patients were included,including 118 patients in the primary suture group.There was no statistical significance between the modified group and the traditional group in gender,age,basic diseases,preoperative laboratory examination,common bile duct diameter,size of common bile duct stone,and nature of common bile duct stone(P≥0.05),and the data were comparable.Comparison of intraoperative data showed that the difference in operative time was statistically significant(P < 0.05).The difference in suture time of common bile duct was statistically significant(P < 0.05).There was no significant difference in intraoperative blood loss(P≥0.05).Comparison of postoperative data between the two groups showed that there were no statistically significant differences in postoperative gastrointestinal recovery time and drainage tube removal time(P≥0.05),but there were statistically significant differences in postoperative hospital stay(P < 0.05).There was no statistical significance in the incidence of postoperative obstructive jaundice,mild postoperative acute pancreatitis and upper digestive tract stress ulcer(P≥0.05).There was statistical significance in the incidence of postoperative bile leakage(P < 0.05).The results of gastrointestinal quality of life assessment showed that there were differences in the results of gastrointestinal quality of life assessment in the first month after surgery between the two groups(P < 0.05),and there was no statistical significance in the recovery between the two groups at the third and sixth month after surgery(P≥0.05).There were 103 patients in the T-tube drainage group.There was no statistical significance between the modified group and the traditional group in gender,age,basic diseases,preoperative laboratory examination,common bile duct diameter,common bile duct stone size,and common bile duct stone nature(P≥0.05),and the data were comparable.Comparison of intraoperative data showed that the difference in operative time was statistically significant(P < 0.05).The difference in suture time of common bile duct was statistically significant(P < 0.05).There was no significant difference in intraoperative blood loss(P≥0.05).Comparison of postoperative data between the two groups showed no statistical significance in postoperative gastrointestinal recovery time,drainage tube removal time and postoperative hospital stay(P≥0.05).There was no statistical significance in the incidence of postoperative obstructive jaundice,postoperative bile leakage,mild postoperative acute pancreatitis and upper digestive tract stress ulcer(P≥0.05).The results of gastrointestinal quality of life assessment indicated that there was no statistical significance in the recovery of patients in the first,third and sixth months after discharge between the two groups(P≥0.05).Conclusion: Laparoscopic choledochal exploration by modified perforation approach is safe and effective for the treatment of choledocholithiasis.Laparoscopic common bile duct exploration by modified puncture hole approach shortens the operation time and reduces the suture time of common bile duct.In the case of primary suture,laparoscopic common bile duct exploration with modified puncture hole approach can reduce the possibility of postoperative biliary fistula,shorten the recovery time of patients and improve the quality of life of patients as soon as possible.