Comparison Of The Application Of Laparoscopic Cystic Duct In The Treatment Of Small Diameter Common Bile Duct Stones Before And After Improvement Of Nasal Bile Duct

Objective: This thesis is to conduct comparative analysis of modified nasal bile duct and ordinary nasal bile duct in the treatment of small diameter common bile duct stones in the clinical curativeMethods: This is a retrospective analysis of 67 cases of gallbladder stones combined with small common bile duct stones admitted from January 2016 to October 2016 into the Department of Hepatobiliary Surgery,Second People's Hospital of Chengdu,which is affiliated to Zunyi Medical College.They were performed laparoscopy Cholecystectomy + cystic duct common bile duct exploration + common bile duct drainage + primary suture(common group).From December 2016 to October 2017,Another 67 cases of gallstone patients with small common bile duct stones were performed laparoscopic cholecystectomy + cystic duct common bile duct exploration + modified nasobiliary drainage + primary suture(modified group),both groups of patients were operated on bythe same group of doctors.Secondly,the clinical data of two groups of patients were collected and comparedwhich include:(1)the basic preoperative information: gender,age,preoperative liver function(ALT,AST,TBIL,DBIL),common bile duct diameter;(2)intraoperative conditions: duodenal incision number,The time of operation,the intraoperative blood loss,the size and number of stone;(3)Postoperative situation: the bile drainage,the time of intestinal function recovery,the time of postoperative biliary drainage,the time of postoperative hospital stay;(4)the incidence of postoperative complications: the main Including pancreatitis,bile leakage,biliary drainage tube off(unplanned extubation),residual stones and other related indicators.Results: Preoperative baseline data(gender,age,preoperative liver function,common bile duct diameter)between the two groups showed no significant difference(P>0.05).Two groups of patients were successfully completed surgery,they were placed ordinary nasobiliary and modified nasal bile duct respectively,no laparotomy,no major bleeding,bile duct perforation,severe pancreatitis and other complications,no case of death.There was no significant difference in operation time,intraoperative blood loss,duodenal incision number and the size and number of stone between the two groups(P>0.05).There was no significant difference in the bile drainage,the time of postoperative biliary drainage and the incidence of postoperative complications between the two groups(P>0.05).The postoperative recovery time of intestinal functional recovery time was shorter than that of the common group(P<0.05).The postoperative hospitalization time was shorter in the improved group than in the normal group(P<0.05).There were no significant differences in postoperative complications between the two groups: pancreatitis,bile leakage and residual stones(P>0.05).The number of nasal bile duct slippage in the modified group was significantly less than that in the normal group(P<0.05).Conclusions: 1.The modified nasal bile duct in the laparoscopic cystic duct treatment of small diameter common bile duct stones can effectively reduce the occurrence of postoperative nasal bile duct slippage,it is safe and effective,has a clinical application value;2.The modified the nasal bile duct can reduce the time of intestinal function recovery and the time of postoperative hospital stay,it has the advantages of early postoperative food intake and rapid recovery.