The Clinical Study On The Indications And Contraindications Of Common Bile Duct Exploration With Primary Suture

Objective: Discuss the feasibility of the common bile duct exploration with primarysuture and its indications and contraindications by compare and analyze the clinicaleffect between primary suture and T-tube drainage after exploration of common bile ductstones.Methods: From January of2011to December of2013, the clinical data of136patients with common bile duct stones in Affiliated Hospital of Yan’an University wasretrospectively analyzed. In this study, we separated the data into two groups by the typeof operation had been done, including56cases of patients who had been treated at theprimary suture were divided into the first group (the observation group) and the otherswho had been treated at T-tube drainage were in the second group (the control group),meanwhile compare the time of operation, the operative blood loss, the volume ofabdominal drainage, the fluid infusion after operation, the hospitalization time afteroperation, the first time of anal exsufflation after operation, the fasting time afteroperation, the rate of bile leakage, the infection rate of surgical incision and the situationof residual stones after operation. All the data was dealt with the SPSS17.0statisticalsoftware, what kind of statistical method used was decided by the type of datadistribution. The measurement data of normal distribution was expressed as mean andstandard deviation, the mean was compared with two independent samples t-test. Themeasurement data of abnormal distribution was expressed as median (25%digits~75%digits)[P50(P25~P75)], the overall distribution was compared with WilcoxonMann-Whitney test. The enumeration data was compared with chi square test. All the statistical analysis was chosen as a reference standard with α=0.05(bilateral) andregarded P<0.05as a statistically significant difference.Results: All the operations were one-time successful. There was no statisticallysignificant difference between two groups (P>0.05) in the time of operation (P=0.904),the operative blood loss (P=0.476), the volume of abdominal drainage (P=0.198), the rateof bile leakage (P=0.879), the infection rate of surgical incision (P=0.557). The twogroups were followed up3~6months after operation, according to B ultrasonographythere were no residual stone and biliary stricture. However, the first time of analexsufflation (P<0.001), the fasting time after operation (P<0.001), the fluid infusion afteroperation (P<0.001) and the hospitalization time after operation (P<0.001) weresignificantly shorter in the observation group than those in the control group (P>0.05).Conclusion: This study retrospectively analyzed the clinical data of patients withprimary suture after exploration of common bile duct stones and T-tube drainage afterexploration of common bile duct stones, the data result shows no significant difference inthe time of operation, the operative blood loss, the volume of abdominal drainage, therate of bile leakage and the infection rate of surgical incision, but the primary suture afterexploration of common bile duct stones is significantly better at reducing the first time ofanal exsufflation, the fasting time after operation, the fluid infusion after operation andthe hospitalization time after operation than the T-tube drainage after exploration ofcommon bile duct stones. So, in the condition of strict controlling the indications andcontraindications, along with the skilled surgical techniques, the primary suture afterexploration of common bile duct stones is a safe, efficient and feasible way to treatcommon bile duct stones. The primary suture after exploration of common bile ductstones can effectively shorten the recovery time and reduce the patients’ pain, so it issuitable to be popularized in clinical.