A Study On Clinical Application Of Laparoscopy Choledochoscopy Combined With Holmium Laser For The Treatment Of Bile Duct Stone

Objective:To investigate the effects and application values of laparoscopic choledochoscope holmium laser treatment of bile duct stones,by compared with laparoscopy choledocholithotomy.Methods:A retospective contrastive analysis was conducted on laparoscopic cholecystectomy+ choledoehotomy under choledochoscope and laparoscopic cholecystectomy+laparoscopic choledochoscope holmium laser treatment of bile duct stones in the department of general surgery of the First Affiliated Hospital of Soochow University and Wuzhong People’s Hospital from January 2015 to December 2016.Among them,there were 60 patients undergoing laparoscopic cholecystectomy+ choledoehotomy under choledochoscope(control group)and 23 patients undergoing laparoscopic cholecystectomy+laparoscopic choledochoscope holmium laser treatment(holmium laser group).The preoperative basic data,operation time,stone removing time,intraoperative bleeding,T-tube placement rate,postoperative gastrointestinal function recovery time,postoperative pain score,postoperative bile leakage rate,postoperative residual stone rate,postoperative hospitalization time and cost were statistically analyzed.Results:The operations in the 83 cases were successful.Preoperation:The preoperation basic data of the two groups(gender,age,bile common duct diameter,stone diameter,white blood cell number.total bilirubin and liver function)was compared between the two groups.P>0.05.There was no statistical significance in the preoperation basic data between the control group and holmium laser group.Intraoperation:(1)Operation time:The operation time of the holmium laser group(93.09±7.42min)was less than that of the control group(113.72±13.15min),P=0.04,which was significantly different(P<0.05);(2)Stone removing time:The stone removing time of the holmium laser group(18.17±3.21min)was less than that of the control group(30.42±7.46min),P=0.018,which was significantly different.(3)Intraoperative bleeding:There was no statistical significance in intraoperative bleeding between the holmium laser group(32.61±8.90ml)and the control group(30.08±8.55ml),P=0.617.(4)T-tube placement rate:The T-tube placement rate in the holmium laser group(3/23)was less than that of the control group(24/60),P=0.000,which was significantly different.Postoperation:(1)Postoperative gastrointestinal function recovery time:There was no statistical significance in postoperative gastrointestinal function recovery time between the holmium laser group(26.22±4.33h)and the control group(25.92±5.03h),P=0.265;(2)Drainage time:There was no statistical significance in drainage volume between the holmium.laser group(6.35±4.22d)and the control group(5.35±3.58d),P=0.079;(3)Postoperative pain score:The postoperative pain score(median)in the holmium laser group(postoperative pain score was 2)was lower than that of the control group(postoperative pain score was 3).P=0.000,which was significantly different;(4)Postoperative hospitalization time;The postoperative hospitalization time in the holmium laser group(9.96±2.93d)was less than that of the control group(12.52±1.30d),which was significantly different.(P=0.000);(5)Postoperative hospitalization cost:The postoperative hospitalization cost in the holmium laser group(10726.80±1323.70yuan)was lower than that of the control group(12052.81±871.13yuan),which was significantly different.(P=0.001);(6)Postoperative bile leakage rate:The postoperative bile leakage rate in the holmium laser group(6/23)and the control group(8/60)was significantly different,(P=0.011);(7)Postoperative residual stone rate:The postoperative residual stone rate in the holmium laser group(0/23)was less than that of the control group(3/60),P=0.024,which was significantly different.[Conclusions]1.Combined use laparoscopic choledochoscope and holmium laser treatment for bile duct stone is safe and feasible.2.Compared with common choledochoscopic stone-removing operation,laparoscopy Choledochoscopy combined with holmium laser treatment has advantages of shorter operation time,shorter stone removing time,lower T-tube placement rate,less postoperative pain,shorter postoperative hospitalization time and less hospitalization expenses.3.The study of the cases of laparoscopy Choledochoscopy combined with holmium laser treatment provides important foundation for better results of this kind of operations.