A Study Of Application Experience And Clinical Efficacy Of Laparoscoic Transcystic Common Bile Duct Exploration And Laparoscopic Common Bile Duct Exploration In Treatment Of Common Bile Duct Stones

Objective: We performed this study to investigate the value and feasibility of Laparoscoic transcystic common bile duct exploration,and to summarize the advantages and disadvantages of the two diffient methods,by comparing the clinical treatment effect of two different operation methods(Laparoscoic transcystic common bile duct exploration LTCBDE and Laparoscopic common bile duct exploration LCBDE)for removal of common bile duct stones,and to provide a treatment experience for clinical work.Methods: This is a retrospective study of patients who underwent surgeries for the gallbladder stones and CBDS(common bile duct stones)in our hospital from December 2015 to December 2018.According to the screening standard and operation methods,among them,31 patients who underwent Laparoscoic transcystic common bile duct exploration into the test group(the group of LTCBDE),and 79 patients underwent Laparoscopic common bile duct exploration,we chose 31 patients in random among them into matched group(the group of LCBDE)by using a random table method.General conditions of patients,blood loss,hospital stay,operation time,hospital expenses,postoperative complications,postoperative pain score,intraperitoneal drainage time,the diameter and number of CBDS were analyzed and compared between the two groups.Results: Compared with the LTCBDE group,the patients in the group LCBDE were older and had a larger diameter of common bile duct,the differences was statistically significant.The rest of preoperative general data in two groups had no statistically significant(P>0.05).None of the patients had a unsuccessful surgery,and two groups had no postoperative deaths.In group LTCBDE,3 patients underwent LTCBDE found no CBDS.CBDS were removed through a T-shaped incision of the cystic duct and common bile duct in 4 patients because of the large diameter of stones,all of them had a primary ductal closure.29 patients were placed abdominal drainage tube,and the other two were not placed abdominal drainage tube because of the wall of the bile duct is smooth and the good function of oddi sphincter.In LCBDE group,all patients were placed T-tube drainage.There was one case of postoperative pleural effusion in the group of LTCBDE.There were one case of bile leakage,one case of calculi residual,and one case of skin ulcer in group of LCBDE.No case of bile duct injury,abdominal cavity infection,postoperative acute pancreatitis occurred in two groups.Comparing the postoperative statistical data of two groups: In LTCBDE group:operation time was(140.16±49.52)minutes,hospital stay was(5.55±2.06)days,blood loss was(25.81±10.58)ml,intraperitoneal drainage time was(5.03±2.26)days,postoperative pain score was(1.84±0.86)scores,the probability of postoperative complications(3.2%),hospital expenses was(3.03±0.69)Ten thousand yuan.The CBD stones diameter was(0.42±0.13)cm.In LCBDE group:operation time was(136.06±37.11)minutes,hospital stay was(8.16±1.68)days,blood loss was(46.29±16.00)ml,intraperitoneal drainage time was(5.03±2.26)days,postoperative pain score was(3.35±1.23)scores,probability of Postoperative complications(9.7%),hospital expenses was(3.38±0.51)Ten thousand yuan.The CBD stones diameter was(0.78±0.37)cm.The difference of operation time and probability of postoperative complications and the number of CBDS between LCBDE group and LTCBDE group was no statistically significant(P>0.05).We can easily find that the group of LTCBDE is better than the group of LCBDE in blood loss,hospital stay,hospital expenses,postoperative pain score,intraperitoneal drainage time,and the diameter of CBDS in LTCBDE group was less than the LCBDE group.And the differences was statistically significant(P<0.05).Conclusions: LTCBDE which is a suitable,feasible,and safe operation method for CBDS,especially for young patiens and smaller stones.Compared with LCBDE,it has less blood loss,and it reduced patient' intraperitoneal drainage time and postoperative pain.Common bile duct injuried can be avoided in LTCBDE so that patients has less hospital stay and lower cost.In terms of surgery,LTCBDE has a extensive surgical indications,but LTCBDE are higher requirements for surgeons in surgical skills.On the premise of strict cases selection and careful and proficient operation,we think that LTCBDE provides a new method for clinicians to treat choledocholithiasis.On the basis of our experience,the surgical indications of LTCBDE : There was no obvious adhesion and anatomic abnormality of the biliary tract.cystic duct diameter>4mm,the number of common bile duct stones < 5,maximum stone diameter <0.6cm.The choice of LTCBDE should accord to the actual and individual clinical condition.Don't do it blindly.