Clinical Analysis Of Minimally Invasive Strategy For The Treatment Of Gallstones With Common Bile Duct Stones By Two-scopy

Objective:To explore the clinical effects of different minimally invasive strategies in the treatment of common bile duct stones with gallstones by using laparoscopic and choledochoscope.Methods:To retrospectively analyze the clinical data of 238 cases of gallbladder stones combined with common bile duct stones treated by laparoscopy and choledochoscopy in our hospital from August 2015 to August 2017.They were divided into 3 groups with according to the different operation methods.Laparoscopic transcystic common bile duct exploration and laparoscopic cholecystectomy(A group of 75 cases).Laparoscopic common bile duct exploration and common bile duct primary suture combined with laparoscopic cholecystectomy(B group of 79 cases).Laparoscopic common bile duct exploration and T-tube drainage combined with laparoscopic cholecystectomy(C group of 84 cases).The preoperative general conditions,operative time,intraoperative blood loss,postoperative hospital stay,hospitalization costs,postoperative complications,and gallstones recurred of the three groups of patients were recorded in detail.The statistical analysis was performed.Results:All patients were successfully operated.In group A,75 patients underwent laparoscopic transcystic common bile duct exploration and cholecystectomy.No Ttubes were placed in the operation.On the basis of laparoscopic cholecystectomy,B group of 79 patients underwent laparoscopic common bile duct exploration and primary suture of common bile duct;C group of 84 cases underwent laparoscopic common bile duct exploration and T-tube drainage.Abdominal drainage tubes were placed in all patients.The preoperative general data of the 3 groups were compared without statistical difference(P>0.05).The data of 3 groups were compared about during operation and postoperative.In group A,there was an advantage in operation time,intraoperative blood loss,hospitalization costs,days of postoperative hospital stay,and postoperative complications compared with group B and C.,and the difference was statistically significant(P<0.05).B group and C group were compared.There was no significant difference in intraoperative blood loss between group B and group C(P>0.05),but the difference was statistically significant in terms of operation time,days of hospitalization,hospitalization costs,group B has obvious advantages over group C and postoperative complications(P< 0.05).The incidence of total complications in the three groups was statistically analyzed.Group A was significantly lower than that in group B and C.However,there was no significant difference between group A and group B(P>0.05).A group and C group were compared,the difference was statistically significant(P< 0.05).B group and C group were compared,the difference was statistically significant(P<0.05).Conclusion:Laparoscopic transcystic common bile duct exploration and laparoscopic cholecy-stectomy treatment of common bile duct stones with gallstones can be beneficial to postoperative recovery,shorten the length of stay in hospital,operation time,reduce intraoperative blood loss,hospitalization costs,and reduce the incidence of postoperative complications.On the basis of effective preoperative assessment,skilled choledochoscope operation,and the mastery of the related surgical techniques.Laparoscopic transcystic common bile duct exploration combined with cholecystectomy for the treatment of gallstones and common bile duct stones is a safe,effective and ideal method.3 kinds of minimally invasive treatment of common bile duct stones with gallstones have advantages and disadvantages,we need to select different surgical methods according to the individual conditions of doctor and patient.