The Clinical Effect Observation And Experience Discussion Of Laparoscopic Common Bile Duct Exploration

Objectives To compare the clinical effects of laparoscopic common bile duct exploration indwelling T tube drainage and non-indwelling T-tube drainage,transcystic duct approach and primary suture after operation in the treatment of cholecystolithiasis complicated with common bile duct stone,and to discuss and summarize the experience,guide clinical work.Methods The clinical data of 164 patients with cholecystolithiasis complicated with common bile duct stone who treated by laparoscopic cholecystectomy and common bile duct exploration from February 2012 to October 2018 were retrospectively analyzed.Among them,14 cases were treated through transcystic duct approach,17 cases were treated with primary suture after common bile duct incision,and 31 patients who through transcystic duct approach and primary suture were included in the non-T-tube drainage group.After choledochotomy,T tube drainage was performed in 133 cases.The data of postoperative complications,patient demographics and clinical results were compared in each group,analysis of intraoperative findings,postoperative complications and comparing the postoperative hospital stay and cost.Results The age,diameter of common bile duct,time of operation,intraoperative infusion,intraoperative hemorrhage,preoperative chronic disease,stone clearance rate,postoperative complications,and total cost of hospitalization in non-T-tube drainage group and T-tube drainage group,there was no significant difference(P>0.05).In non-Ttube drainage group,compared with T-tube drainage group,the proportion of women was larger,the incidence of acute cholecystitis before operation was lower,the number of choledocholithiasis was less,the number of silt-like stones was less,the postoperative hospitalization time was shorter,and the incidence of bile leakage was higher.The difference was statistically significant(P<0.05).There attributes had no significant difference in transcystic duct approach group and primary suture group,which included the gender,preoperative chronic disease,preoperative acute cholecystitis,diameter of choledochal duct,number of choledocholithiasis,silt-like stones,time of operation,intraoperative hemorrhage,stone clearance rate,total postoperative complications,and total cost of hospitalization(P>0.05).Compared with the primary suture group,the transcystic duct approach group had younger age and more intraoperative infusion,the difference was statistically significant(P<0.05).Conclusions Non-indwelling T-tube drainage after laparoscopic common bile duct exploration is as safe and effective as indwelling T-tube.It has the advantages of quick recovery and short hospitalization time.However,the postoperative biliary leakage is worthy of careful evaluation and consideration before and during the operation.The transcystic duct approach must be treated individually on the premise of satisfying the indications of operation,and good results can be obtained.The reliability of T-tube drainage after operation is high,which can be used as the final alternative for other surgical procedures.Table5;Reference 155.