Analysis Of The Curative Effect Of Laparoscopic Common Bile Duct Exploration With Primary Suture

Objectives:To compare the efficacy of primary suture and T-tube drainage in laparoscopic common bile duct exploration for the treatment of choledocholithiasis,and the difference between laparoscopic surgery and open surgery,to analyze the possible influencing factors of postoperative complications of common bile duct exploration,and to discuss the feasibility of intraoperative primary suture of common bile duct.Methods:The clinical data of patients with common bile duct calculi underwent surgery in the Hepatobiliary Department of the First Affiliated Hospital of Soochow University from January 2016 to November 2018 were analyzed retrospectively.A total of 79 cases of patients were included.They were divided into primary suture group(n=41),and T-tube drainage group(n=38).General information,the first day of preoperative and postoperative laboratory index,operation time,intraoperative blood loss,postoperative eating time,postoperative hospitalization days and incidence of complications and follow-up time of the patients were compared between two groups.Results:There were significant differences in preoperative c-reactive protein(CRP),total bilirubin(TBil)and direct bilirubin(DBil)between the primary suture group and the T-tube drainage group(P<0.05).The postoperative feeding time and postoperative hospital stay in the primary suture group were shorter than those in the T-tube drainage group,and the complication rate was lower,the difference was statistically significant(P<0.05).Laparoscopic surgery was superior to open surgery with respect to intraoperative blood loss,postoperative feeding time and postoperative hospital stay,and the difference was statistically significant(P<0.05).Postoperative complications occurred in twelve patients,with a complication rate of 15.2%,including recurrence of stones in seven patients,biliary tract infection in two patients,biliary tract stenosis in one patient,biliary leakage in one patient,and pancreatitis in one patient,without biliary peritonitis,pulmonary infection,incision infection and other complications.Primary suture or T-tube drainage,number of stones,preoperative TBil,preoperative white blood cell count and postoperative DBil may be the influencing factors of postoperative complications(P<0.05).Binary logistic regression analysis showed that the number of stones may be an independent risk factor for postoperative complications.Long-term postoperative follow-up was conducted for all patients with choledocholithiasis after surgical treatment,with an average follow-up time of(16.5±2.2)months.At 3 months,6 months and 1 year after surgery,the complication rate of the primary suture group was significantly lower than that of the T-tube drainage group(P<0.05).Kaplan-Meier survival analysis suggested that the complication-free survival of the primary suture group was significantly longer than that of the T-tube drainage group(P<0.05).Conclusions:It is safe and reliable to perform primary suture of common bile duct in laparoscopic common bile duct exploration on the premise of fully grasping the indications of surgery.Compared with T-tube drainage,primary suture has the advantages of less surgical trauma,faster recovery,shorter treatment time and lower complication rate,and is worthy of further promotion and application in clinical practice.