Application Of Accelerated Rehabilitation Surgery In The Treatment Of Gallstone With Extrahepatic Cholelithiasis By Laparoscopy Combined With Choledochoscope

Objective:To explore the clinical effect of the concept of accelerated rehabilitation surgery in the treatment of cholecystolithiasis combined with extrahepatic choledocholithiasis.Methods:From September 2018 to September 2019,58 patients with cholecystolithiasis and extrahepatic choledocholithiasis who were treated by laparoscopy and choledochoscopy were selected from hepatobiliary and pancreaticobiliary surgery of the first hospital of Shanxi Medical University.29 patients in group A and 29 patients in group B were randomly selected by random number table method.The patients in group A were given routine treatment plan in perioperative period,and those in group B were given accelerated rehabilitation surgical treatment plan in perioperative period.Among them:1.the general situation includes gender,age,BMI,preoperative leukocyte level;2.the operation situation includes intraoperative blood loss and operation time;3.the postoperative recovery situation includes the first time to get out of bed,the first time to exhaust gas,the first time to eat food,the time to remove drainage tube,the time to stay in hospital,the pain score of 6h after operation and 1D after operation WBC level;4.complications mainly include lung infection,vomiting,abdominal infection,bleeding,bile leakage.Results:General situation:group A(29 cases),group B(29 cases),18 men and 11women in group A,39-72 years old,age average(54.62±4.18)years old,BMI index(23.54±6.28)kg/m~2,preoperative WBC level(5.81±0.79)×10~9/L,19 men and 10women in group B,38-71 years old,age average(54.13±4.06)years old,BMI index(23.16±6.14)Kg/m~2,preoperative WBC level(5.90±0.84)×10~9/L.There was no significant difference between the two groups(P>0.05).Operation condition:the intraoperative blood loss and operation time of group A were(50.95±21.63)ml and(127.31±15.74)min,respectively,while those of group B were(46.73±21.41)ml and(123.08±15.56)min,respectively.There was no significant difference between the two groups(P>0.05).Postoperative recovery:the first time to get out of bed,the first time to exhaust,the first time to eat,the time to remove the drainage tube,Postoperative hospital stay,the pain score at 6 hours after operation and the first day after operation in group A The WBC levels were(21.68±4.27)h,(36.21±5.12)h,(48.62±6.59)h,(3.71±1.06)d,(9.03±3.01)d,(4.15±1.37)point,(13.64±1.58)×10~9/L,respectively;the first time of getting out of bed,the first time of exhausting,the first time of eating,the time of removing drainage tube,Postoperative hospital stay,the score of pain at 6h after operation and the first day after operation in group B WBC levels were(12.35±2.74)h,(25.84±4.61)h,(23.93±4.38)h,(1.88±0.92)d,(5.87±1.86)d,(2.39±0.52)point,(10.57±1.31)×10~9/L,respectively.There was significant difference between the two groups(P<0.05).Complications:the incidence of complications was 27.59%(8/29)in group A and 6.90%(2/29)in group B.Compared with the two groups,group B was significantly lower(P<0.05).Conclusion:The concept of accelerated rehabilitation surgery was applied to the patients with gallstone and extrahepatic cholelithiasis treated by laparoscopy and choledochoscope.It was found that the integration of the concept can effectively promote the postoperative rehabilitation of patients and reduce the risk of complications.