The Application Of Laparoscopy Combined Choledochoscopy And Duodenoscopy In The Treatment Of Secondary Common Bile Duct Stone

Objectives:This study is designed to observe the application of laparoscopic,combined choledochoscopy and duodenoscope and the selection of different methods and procedures in the surgical treatment of a secondary common bile duct stone,and to observe and compare the different combination methods and timing of surgery,including the operation time,intraoperative blood loss,abdominal drainage time,postoperative hospital stay,total hospital stay,total hospitalization cost,etc.To explore different combined method and timing of surgery in secondary common bile duct calculi treatment in the clinical application effect and advantages and disadvantages,thought afterwards secondary common bile duct stone of laparoscopic,combined choledochoscopy and duodenoscope clinical surgical treatment methods and the choice of timing to provide reference and basis.Methods:Retrospective analysis on January 1,2015 to February 2018 admitted to our hospital to accept the laparoscopic,combined choledochoscopy and duodenoscope treatment of 83 cases of secondary common bile duct calculi in patients with clinical data.Based on the extent of the bravery and the choice of surgical methods,there are three large groups:The diameter of the common bile duct in group A was less than 0.8cm.In combination treatment of that row ERCP + EST + ENBD +LC,the nasocannula of the A-1 group has A concurrent ERCP + EST + ENBD + LC operation;A-2 groups were followed by ERCP+EST+ENBD for 24 hours after surgery;In group B,that diameter of the common bile duct is 0.8cm,less than 1.2cm,in the same period the nasal intubation anesthesia downlink LC + LD + bile duct/plastic biliary stent implantation + first phase of the common bile duct suture,line B-1 set of sequential ERCP + ENBD + LC + LD + the first phase of the common bile duct suture technique;The B-2 sequence is in the series of LC + LD and plastic gallbladder stents and the first stage of the gallbladder suture + ERCP;The group C of bile duct diameter>1.2cm line LC+ laparoscopic choledochotomy to explore the stone + primary suture.Observation indicators:(1)general clinical data;(2)preoperative related inspection and inspection indicators;(3)operation time and intraoperative blood loss;(4)postoperative complications:pancreatitis,bile leakage and residual stones;(5)economic indicators such as postoperative hospitalization days,total length of stay and total hospitalization expenses,after collecting and collating data,SPSS22.0 statistical software was used for statistical analysis,and compared with the general clinical data of A-1 group and A-2 group,B-1 group and B-2 group,group B and group C,and the results of preoperative examination and test results were compared,further discussing whether there was difference between operation time,intraoperative blood loss,indwelling drainage tube time,postoperative hospital stay,total length of hospital stay,total hospitalization expense and complication rate.Results:The general clinical data and related preoperative related test results:after statistics analysis,A-1 group and A-2,1B and B-2 group between the two groups in gender,age,hypertension,diabetes mellitus,preoperative liver function examination index(AST,ALP,GGT,CHE,TBIL,DBIL,IBIL),stone of bile duct diameter,maximum diameter,etc were no obvious difference;There was no statistically significant difference between group B and group C in terms of gender,age,preoperative liver function test(AST,ALP,GGT,CHE,TBIL,DBIL,IBIL),and bile duct internal diameter;Postoperative conditions:there was no statistically significant difference between the incidence of postoperative complications,postoperative hospitalization days,and intraoperative blood loss.A-1 group was significantly higher than the A-2 group in LC operation time,abdominal drainage time,and surgical postmark,but the a-1 group was significantly lower than the A-2 group in total hospitalization expense and total hospitalization time,and the difference was statistically significant(p<0.05).Group B and group C incidence of postoperative complications,operative time,intraoperative blood loss,indwelling abdominal drainage time,total cost of hospitalization and other indicators are no significant statistical difference.However,postoperative hospitalization time and total length of stay in group B were significantly lower than that in group C,and the difference was statistically significant(p<0.05).Conclusion:According to the specific conditions of the disease,choose reasonable and standardized treatment methods.For patients with no significant dilation(d<0.8cm),the nasal intubation was followed by ERCP+EST+ENBD+LC.For common bile duct expansion(0.8cm<d<1.2cm),the nasal intubation was followed by LC+LD+ plastic biliary stent implantation and the first stage suture+ERCP.For patients with biliary duct diameter>1.2cm,laparoscopic cholecystectomy and choledochotomy were performed for the treatment of secondary choledocholithiasis,and the clinical efficacy was good,safe and feasible,significantly shortening the hospitalization expense,length of stay,and improving the quality of postoperative life without increasing the incidence of pancreatitis,bile leakage and residual stones.In the medical center with good anesthesiologist and skilled in the operation of laparoscopy,choledochoscope and duodenoscopy,we have the advantag’e of strict surgical indications and full expression of various treatment methods,so as to benefit the patients who have the common bile duct stones.