Clinical Efficacy Of Laparoscopic Transcystic Common Bile Duct Exploration For Common Bile Duct Stones

Objective:This study will analysis the feasibility by comparing the treatment of common bile duct stones between Laparoscopic transcystic common bile duct exploration(LTCBDE)and Laparoscopic choledocholithotomy plus T-tube drainage(LCTD),to provide a reliable basis for the clinical work.Methods:Selecting 68 patients with gallbladder stones and common bile duct stones in Zhong Shan Hospital Xiamen University from January 2014 to December 2016,these patients are divided into observation group(31 cases)and control group(37 cases)according to different surgical approach,the patients in observation group had the LTCBDE while the patients in control group had the LCTD,then comparing the clinical indicators,such as operation time,intraoperative blood loss,anal exhaust time,length of hospital stay,hospitalization expenses,and postoperative complications(including bile leakage and bile peritonitis,acute pancreatitis and biliary tract bleeding,bile duct perforation,abdominal cavity infection,postoperative residual stones,etc).Results:All surgery were successfully completed with no postoperative deaths.The two groups are comparable because the age,gender,common bile duct diameter,the number of common bile duct stone of these two groups had no significant difference(P>0.05).As for the observation group(LTCBDE),the operation time was(111.41±31.02)minutes,the intraoperative blood loss was(12.25±3.12)ml,the anal exhaust time was(1.52±0.57)days,the length of hospital stay was(8.19±2.65)days,the hospitalization expenses was(18041.06±4669.65)Yuan,there were 1 case of po stoperative acute pancreatitis and 1 case of residual stones,the incidence of postoperative complications was 6.4%(2/31);As for the control group(LCTD),the operation time was(138.05±28.91)minutes,the intraoperative blood loss was(26.22±7.58)ml,the anal exhaust time was(1.97±0.50)days,the length of hospital stay was(10.84±2.01)days,the hospitalization expenses was(22043.68±3011.35)Yuan, there were 2 case of postoperative acute pancreatitis,3 cases of bile leakage,4 cases of residual stones and 1 case of infection of incisional wound..The incidence of postoperative complications was 27.0%(10/37).There were no complications like bile peritonitis,biliary tract bleeding,biliary tract perforation,abdominal cavity infection,etc.It's clearly to see that the operation time,intraoperative blood loss,anal exhaust time,length of stay,hospitalization expenses and the incidence of postoperative complications in observation group(LTCBDE)were all lower than that in the control group(LCTD),and the difference is statistically significant(P<0.05).Conclusions:Laparoscopic transcystic common bile duct exploration(LTCBDE)has the advantages of small surgical wound,quick recovery,low hospital expenses,low rate of incidence complication and so on,which make it a kind of safe,effective and economic surgical approach,its clinical effect is better than that of Laparoscopic choledocholithotomy plus T-tube drainage(LCTD).It can be used as the first choice for treating common bile duct stones with the premise of mastering the reasonable surgical indications,contraindication and rich in laparoscopic and choledochoscope technology.