The Comparing Research Of The Combined Appliances Of Two Endoscopies With Open Surgery In The Treatment Of Extrahepatic Bile Ductt Stones

Objective:To explore the safety and efficacy of laparoscopy combined with choledochoscope in the treatment of extrahepatic bile duct stones.Methods:According to different treatment methods,92 patients with extrahepatic bile duct stones were divided into two groups,51 cases were treated with laparoscopy combined with endoscopic therapy;in the control group,41 patients were treated with open cholecystectomy,choledochotomy and t-tube drainage.The time of operation,gastrointestinal function restoration and hospital stays,postoperative liver function recovery,immune response and complications were compared between the two groups.Results:(1)The operation was successful in 49 cases(96.08%)in the double mirror group,and 2 cases were transferred to the abdomen.The reason for the transfer: 2 patients were transferred to the abdomen due to the serious adhesion of gallbladder triangle.In the control group,40 cases(97.56%)were successful and 1 case of biliary intestinal anastomosis.The reason of biliary anastomosis: the patient was treated with choledochojejunostomy because of the narrow end of the choledochotomy.The results showed that both groups had a higher success rate in operation,and the difference was not statistically significant(P > 0.05).(2)Postoperative complications: There was 1 case of complications in the double mirror group,and the incidence rate was 2.04%.There was 1 patient with biliary fistula,and the operation was cured after laparoscopic surgery,without incisional hernia;in the control group,there were 3 complications,and the complication rate was 12%.In 1 case,jaundice was found in patients with biliary stricture,and the biliary intestinal anastomosis was performed;one case was infected with incisional wound;one of the elderly patients with chronic bronchitis had incisional hernia,and there was no tension hernia repair.The success rate of the two groups and the incidence of postoperative complications were not statistically significant(P > 0.05);but the overall incidence of complications were less than the control group,the difference was statistically significant(P < 0.05).(3)The time of operation of the double mirror group(175.5±9.5)min,the recovery time of gastrointestinal function(1.96±0.72)day,and hospital stay(4.18±0.71)day were all better than the control group,and the difference was statistically significant(P< 0.05).Postoperative calcitonin(1.09±0.34)ng·ml on 3 days after surgery;In the control group,calcitonin(14.18±3.5)ng·ml was reduced after 3 days,and the difference was statistically significant.Doublelens postoperative 3,aspartate transaminase(60.69±24.6)U/L,total bilirubin(29.29±4.28)μmol/L,direct bilirubin(17.06±3.71)μmol/L,alanine aminotransferase(81.31±18.13)U/L,gamma GT(206.06±86.83)and total bile acid(10.49±4.58)μmol/L,compared with control group,there was no statistically significant difference(P > 0.05).Conclusions:The time of operation,the recovery time of gastrointestinal function,the time of hospitalization,the immune response of the body and the overall incidence of complications were better than the control group,and the difference was statistically significant.Joint choledochoscope,according to the results of laparoscopic treatment of extrahepatic bile duct stones curative effect,and with short operation time and quicker recovery of gastrointestinal function,short hospital stay,lower the body’s immune response,the advantages of low overall incidence of complications,with the value of popularization and application of the clinical practice.