| BackgroundWith the progress of medical technology,the treatment of cholecystolithiasis accompanied with choledocholithiasis has been developed from laparotomy to a variety of minimally invasive methods.Endoscopical assisted retrograde cholangiopancreatography combined with duodenal papillotomy or balloon dilatation,and the use of lithotripsy or stone removal instruments,has a high clearance rate for common bile duct stones,making it important in the treatment of common bile duct stones.Laparoscopic cholecystectomy can be performed simutanuously orheterochronously.However,endoscopic treatment may damage the normal structure of Oddi's sphincter,the long-term complications after treatment have become important.Laparoscopic exploration of common bile duct stones in different ways will not destroyed the function of Oddi's sphincter,and can be used to treat gallstones with cholecystectomy at the same time,which can avoid the burden on patients caused by two surgical procedures under endoscopy According to different conditions of patients,there are different combinations of surgical procedures.The therapeutic effects of various types of surgery are worth further exploration.ObjectiveThrough the comparison of different clinical indexes of the 4 different groups of surgical treatment of cholecystolithiasis and choledocholithiasis,the scientific rationality and indications of various kinds of surgical treatment are explored.This may provide patients with appropriate individualized surgical methods.MethodsThe clinical data of patients with cholecystolithiasis and choledocholithiasis in Wuhan general hospital admitted to general surgery from January 2016 to December 2017 were collected.There were 103 patients in accordance with the inclusion criteria and were divided into 4 groups according to different surgical methods.group A:Laparoscopic cholecystectomy+common bile duct exploration+T tube drainage.group B:Open cholecystectomy+common bile duct exploration.group C:Laparoscopy combined with choledochoscopy and duodenoscopy cholecystectomy plus biliary tract exploration.group D:Laparoscopic cholecystectomy + transcystic common bile duct exploration.The clinical observation indexes include:(1)general situation:age and sex;(2)Preoperative and postoperative total bilirubin,direct bilirubin,white blood cell count;(3)Operation time(H)and intraoperative bleeding(ML);(4)Postoperative gastroenteric ventilation time(d),eating time(d),drainage tube removal time(d),postoperative hospital stay(d),total hospital stay(d);incidence of incision infection(%).Clinical data was analyzed with SPSS22.0 statistical software.Measured data are expressed as mean±standard deviation(X±s),analysis of variance is used;count data are expressed as rate,and chi-square test is used.P<0.05 was a statistically significant difference.Results1.General situation:there was no statistically significant difference in ages and sex in the 4 groups(P>0.05),and the data were comparable.2.Biochemical indicators:there was no significant difference in total bilirubin,direct bilirubin and white blood cell count in the 4 groups before and after discharge(P>0.05).3.Surgical related indicators:3.1 Operation time The operative time of the 4 groups were 148.79±43.55min,157.07±55.93min,198.50±50.59min and 182.90±30.72min,respectively.There was a significant difference in the four groups(F=5.949,P<0.01).The operation time of group A was significantly shorter than that of C and D groups,and it has significant differences(P<0.05).There was no significant difference in the operation time between the group A and group B(P>0.05).There was no significant difference in the time of operation in group B compared with group C(P>0.05).There was no significant difference in the operation time between the C group and the D group(P>0.05).3.2 Intraoperative blood loss The intraoperative blood loss in the 4 groups were 64.84±41.76ml,157.07±116.26ml,59.00±19.44ml,and 59.52±26.74ml,respectively.There was a significant difference between the four groups(F= 18.05565,P<0.01).The amount of bleeding in group A was significantly lower than that in group B,and there was a significant difference(P<0.01).There was no significant difference in the amount of bleeding in group C and group D(P>0.05).The group B was significantly more than other groups,and there was a significant difference(P<0.01).There was no significant difference in the amount of bleeding between group C and group D(P>0.05).4.Clinical outcome related indexes4.1 Postoperative ventilation time The postoperative ventilation time of the 4groups was:1.82±0.39d,3.14±0.915d,2.45±0.60d,2.29±0.46d,There was a significant difference in the four groups(F=22.738,P<0.01).group A was significantly smaller than the B,C,and D groups,with significant differences(P<0.01).Group B was greater than group C and D,with significant difference(P<0.05).There was no significant difference in intraoperative blood loss between group C and group D(P>0.05).4.2 Postoperative eating time The postoperative eating time of the four groups was 2.64±0.48d,4.24±0.73d,3.00±0.72d,and 2.81±0.98d,respectively.There was a significant difference in the four groups(F=29.046,P<0.01).group A was significantly smaller than group B,with significant differences(P<0.01).Compared with group C and D,there was no significant difference(P>0.05).group B was significantly larger than other groups,with significant differences(P<0.01).There was no significant difference between group C and group D(P>0.05).4.3 Abdominal drainage tube removal time The removal time of postoperative abdominal drainage tube in the 4 groups was 4.64±1.13d,7.34±6.78d,5.7±2.36d,4.90±0.62d,respectively.There was a significant difference in the four groups(F=2.946,P<0.05).group A was less than group B,there was a significant difference(P<0.01).Compared with group C and D,there was no significant difference(P>0.05).There was no significant difference between group B and group C(P>0.05).Group B was greater than group D and there was a significant difference(P<0.05).There was no significant difference between group C and group D(P>0.05).4.4 Postoperative hospitalization time The length of hospital stay after surgery was 7.73±2.36d,11.76±7.03d,9.45±3.50d,and 6.71±1.23d,respectively.There was a significant difference in the four groups(F=7.00,P<0.01).group A was significantly smaller than group B,with significant difference(P<0.05).Compared with group C and D,there was no significant difference(P>0.05).There was no significant difference between group B and group C(P>0.05).There was a significant difference between group B and group D(P<0.01).There was a significant difference between group C and group D(P<0.05).4.5 Total hospitalization time The total length of stay in the 4 groups was 12.52±4.61d,15.31±7.12d,17.95±10.56d,and 11.05±3.91d,respectively.The F value in the four groups was 4.489.There was a significant difference(P<0.01).Group A was smaller than group C,and there was significant difference(P<0.01).There was no significant difference compared A group with group B and D(P>0.05).There was no significant difference between group B and group C(P>0.05).Group B was significantly greater than group D,and there was a significant difference(P<0.05).Group C was significantly greater than group D,and there was a significant difference(P<0.01).4.6 Incidence of complications There was no significant difference in the incidence of postoperative bile leakage in the 4 groups(P>0.05).Incidence of incision infection was significantly higher in group B than in the other three groups(the difference between group A,group C,and group D was not statistically significant).There was a significant difference(P<0.01).ConclusionsThe 4 groups are effective methods for the treatment of cholecystolithiasis and choledocholithiasis.The number of cases in group A was relatively large.The results showed that the technology indications were relatively wide and the technical operation was more skilled.Group C and group D were safe and effective,with less operative trauma,which were accords with the concept of accelerated rehabilitation surgery.However,group C required multiple techniques for joint operation.Group D was affected by the special anatomy of the cystic duct into the common bile duct The exploration of the bile duct system above the confluence department was poor,and both groups had high requirements for the surgeon and the team's technical operation,and has strictly indications.Although all kinds of laparoscopic surgery have been widely used in clinic,it is necessary to choose open surgery to avoid biliary tract injury in patients with severe cholangitis,dense upper abdomen adhesion and difficult laparoscopic lithotomy. |
PDF Full Text Request