| Objective(s):To compare the clinical efficacy of three-mirror combined choledochotomy in treating elderly patients with diabetes mellitus and extrahepatic cholelithiasis with indwelling T tube drainage after three-mirror combined choledochotomy and to evaluate the safety of three-mirror combined with extrahepatic cholelithiasis in elderly DM patients.Methods:This study is a retrospective clinical study.We collected collected from January 2017 to September 2019,from the Second Affiliated hospital of Kunming Medical University admitted extrahepatic cholelithiasis patients with DM in hospital surgery and postoperative outpatient review follow-up data,and finally selected 87 cases(male 40/female 47)meeting the experimental cases,of which 40 cases were successfully completed the same period of laparoscopic choledochotomy exploration bile duct primary suture(LBEPS)+laparoscopic cholecystectomy(LC)+nasobiliary drainage(ENBD),referred to as group P;the other 47 cases were successfully completed laparoscopic choledochotomy exploration(LCBDE)+laparoscopic cholecystectomy(LC)+ T tube drainage referred to as group T.Spss22.0 statistical software was used to analyze the data differences of sex,age,blood glucose control level,liver function(alt,AST,TBIL,DBIL,ALB),internal diameter of common bile duct and the number of stones between the two groups before operation.The operation time,total bleeding volume,bile drainage volume on the first day after operation,recovery time of gastrointestinal function,and retention time of abdominal drainage tube were compared between the two groups The statistics were completed and the analysis results of the research data were obtained.Results:The results showed that there was no significant difference in blood glucose control level(7.17±0.71.7.07±0.74)mmol/L,ALB(48.97±12.87,48.43±13.78)g/L,bile duct diameter(1.26±0.07,1.27±0.08)cm and liver function difference between group P and group T(P>0.05).The number of stones(2.30±0.85,2.15±0.81),the total blood volume(57.60±16.05.67.67±15.00)ml and the Stone diameter(0.82±0.36,0.85±0.39)cm,There was no significant difference between the two groups(P>0.05);But in the operation time(106.40±20.72,105.79±19.69)min,the first day after operation Bile drainage volume(237.25±43.91.235.85 ±38.93)ml,After operation,the recovery time of gastrointestinal function(40.53 ±5.47,48.83± 7.09)h,the retention time of abdominal catheter(4.18± 0.99,5.71 ±1.79)days,the hospitalization time(6.32± 1.33,7.96± 1.71)days,and the total hospitalization cost(30082.07± 5262.67,34605.47± 9598.15)yuan were statistically significant(P<0.05).Compared with the patients in T group.The operation time of group P were superior.The patients in P group had earlier postoperative gastrointestinal ventilation,earlier fluid diet,better postoperative rehabilitation,significantly shorter postoperative hospital days,and reduced the total cost of hospitalization.There was no significant difference between the two groups in bile leakage,acute pancreatitis,bile duct stenosis,stone residue and other complications(P>0.05),but the incidence of abdominal infection after T-tube indwelling was significantly higher(14.89%)than that in the first stage suture group(2.5%)(p=0.046<0.05),a case of wound infection of drainage tube occurred in group P,and in the postoperative recovery,there were 2 patients in T-tube group with cellulitis of skin tissue around T-tube,and 2 patients with T-tube Retrograde infection,1 case of T-tube accidental falling off and 2 cases of bile leakage after 3 months of extubation were cured and discharged after conservative medical treatment.Conclusion:Compared with LCBDE+T tube drainage operation,the operation of lbeps combined with ENBD in the treatment of extrahepatic bile duct stones in elderly DM patients not only reduces the operation time.but also reduces the recovery time of gastrointestinal function,postoperative time with tube and postoperative hospital stay,which also reduces the cost of hospitalization.During the operation,nasobiliary drainage was placed through abdomen to supplement the indication of simple primary suture of common bile duct,which can fully drain bile,reduce the pressure of bile duct after operation,effectively prevent bile leakage,avoid the complications of long-term retention of T tube,and improve the quality of life of patients after operation.Therefore,on the basis of full evaluation of the patient's condition,it is safe and effective to carry out LBEPS+ENBD under the same period of three endoscopes in the treatment of extrahepatic cholelithiasis patients with diabetes. |
PDF Full Text Request