| BackgroundCholelithiasis is a common benign disease of the biliary system,with an incidence of about 10% in China,of which about 15% of symptomatic cholelithiasis are associated with common bile duct stones.Once choledocholithiasis is diagnosed,regardless of clinical symptoms,surgical removal of the stone is recommended,but no matter which surgical method is adopted,postoperative stone recurrence cannot be completely avoided,the recurrence rate of stones is about 10%.In the face of patients with recurrent choledocholithiasis,clinicians need to consider which surgical approach will provide the greatest benefit to the patient.ObjectiveTo compare the efficacy and safety of laparoscopy combined with choledochoscopy and traditional open choledocholithotomy in the treatment of recurrent choledocholithiasis.MethodA retrospective analysis of the clinical data of 92 patients with common bile duct stones with a history of bile duct surgery,these patients were admitted to the General Surgery Department of Nanyang Central Hospital from January 2017 to December 2020.These patients were divided into control group and observation group according to the operation method.Laparoscopic combined with choledochoscopy was performed in control group,and traditional open surgery was performed in observation group.The general data and related clinical indicators of the two groups of patients were compared.Results1.Comparative the general data of the two groups of patients,the difference was not statistically significant.（P>0.05）.2.Intraoperative blood loss,C-reactive protein value,postoperative recovery time of gastrointestinal function,and postoperative hospital stay in control group were（55.11±19.54）ml,（26.67±26.81）mg/l,（2.54±0.91）days,and（5.15±1.10）days,respectively,which were significantly lower than observation group（78.04±27.62）ml,（38.99±25.86）mg/l,（3.00±0.89）d,（7.78±2.03）d,the difference was statistical significance（all P<0.05）.3.The operation time of control group was（176.63±19.12）min,which was apparently longer than observation group（151.52±18.79）min,the difference was statistical significance（P<0.05）.4.The inpatients costs of control group was（2.07±0.71）ten thousand yuan,which was higher than observation group（1.82±0.76）ten thousand yuan,the difference was not statistically significant（P>0.05）.5.The probabilities of postoperative incision infection,intraperitoneal hemorrhage,perforation,pancreatitis,bile leakage,residual stone and biliary stricture were compared between the two groups,the difference was not statistically significant（P>0.05）.Conclusion1.Laparoscopic combined choledochoscopy and laparotomy are safe,reliable,and effective in patients with recurrent choledocholithiasis.2.Compared with open surgery,laparoscopy combined with choledochoscopy has the advantages of less trauma and faster postoperative recovery in the treatment of patients with recurrent choledocholithiasis,which is worthy of further clinical application.3.In clinical practice,various factors such as the patient’s age,stone size and number should be comprehensively considered to select the appropriate surgical method. |
