The Clinical Comparative Study Of "Uncut Roux-en-Y" Laparoscopic Choledochojejunostomy

Objective:1、To investigate the advantages and disadvantages of laparoscopic Roux-en-Y Choledochojejunostomy(LCJS) were compared with open Roux-en-Y Choledochojejunostomy.2、To find the advantages and disadvantages of laparoscopic UnRoux-en-Y Choledochojejunostomy were compared with LCJS.And to discuss that if those advantages of thelaparoscopic UnRoux-en-Y Choledochojejunostomy can make up for those disadvantages of open Roux-en-YCholedochojejunostomy.3、To discuss that if laparoscopic Uncut Roux-en-Y choledochojejunostomy is a safe, reliable and feasible sugical approaches, and whether it is worth promoting.Methods:The object of study was the clinical data of Choledochojejunostomy by biliary tract disease in the second affiliated hospital of kunming medical university from June 2014 to December 2014:Open surgery of Roux en-Y Choledochojejunostomy (group A),22 patients, including 9 cases of male and female 13 cases, aged 25 to 79 years old, the average years of age(51.7 ± 12.8); Roux-en-Y Laparoscopic Choledochojejunostomy (group B),20 patients,8 cases of menand female 12 cases, aged 26 to 71 years old, average (50.1± 11.9)years old;And at the same time,the Uncut Roux en-Y Laparoscopic Choledochojejunostomy (group C) in 18 patients,7 cases of men, women in 11 cases, aged 21 to 68 years old, average age (49.9±12.9).The patients with preoperative showed different degrees of jaundice, chills, fever, and hepatic function change, preoperative clinical commonly used Child classes, evaluation of hepatic function of patients.Operation method for A, B, C three groups respectively to collect preoperative, intraoperative and postoperative data lines of group A and group B, group B and group C line of comparative research.Results:preoperative:Group A(Open surgery of Roux en-Y Choledochojejunostomy), group B(Roux-en-Y Laparoscopic Choledochojejunostomy), group C (Uncut Roux-en-Y Laparoscopic Choledochojejunostomy) of patients with preoperative basic information including age, gender and grade of the child of hepatic function, total bilirubin levels, albumin concentration and prothrombin time and the case to complete statistical processing.The results was no statistical differences, (P> 0.05).That means the preoperative data was comparable.Intraoperative:The operation time group A was short than groupB; And group C was shorter than group B significantly;(p< 0.05), with statistical significance,postoperative:The time of recovery ofpostoperative gastrointestinal function group B shorter than group A, (P< 0.05). with statistical significance.But the total bilirubin level after surger on the first day,third day and after one week was no difference in both groups,(P> 0.05),with statistical significance.But the total hospitalization expenses of group B was higher than that of group A, (p< 0.05),with statistical significance.Group C compared with group B intraoperative blood loss, postoperative gastrointestinal to restore time, postoperative hospitalization days and total hospitalization costs significantly less than group B, (p< 0.05),with statistical significance.The operation time of group C was significantly shorter than that of group B (P=0.010),with statistical significance; The total bilirubin level after surger on the first day and after one week was no difference in both groups,(P> 0.05),but on the third day group C were lower than group B,P=0.000,with statistical significance.Group A,5 cases infection of incision,significantly higher than that of B and C.The case of bile back-streaming of A and B two groups were significantly higher than C.Conclusion:1, Roux-en-Y laparoscopic choledochojejunostomy have a small incision, wound infection rate, less bleeding, rapid postoperative recovery, shorter hospital stay compare with open Roux-en-Y choledochojejunostomyand and the curative effect can achieve the same effect. However, due to surgery for a long time, high hospital costs, long learning curve limiting the promotion of the surgical approach.2,We can get that Uncut Roux-en-Y laparoscopic choledochojejunostomy spent shorter operative time and shorter than the laparoscopic surgery costs,and have faster postoperative recovery of gastrointestinal function, surgical more simple, better postoperative biliary drainage effect compare with Roux-en-Y laparoscopic Choledochojejunostomy3, Laparoscopic Uncut Roux-en-Y choledochojejunostomy safe, reliable, practical, good effect is worth promoting.