Efficacy Analysis And Clinical Study Of Laparoscopic Combined With Choledochoscopy In Patients With Common Bile Duct Stones Undergoing Abdominal Reoperation

Background and purposeCholelithiasis is the main disease and frequently-occurring disease of the digestive system.In recent years,due to the increase in the intake of high-fat diet,the incidence of cholelithiasis has also increased rapidly.Choledocholithiasis can easily lead to complications such as bile duct obstruction,secondary cholangitis,gallstone pancreatitis and obstructive jaundice,which are life-threatening.Therefore,once diagnosed,intervention and treatment should be carried out as soon as possible.At present,there are many methods and methods for the treatment of choledocholithiasis,but the application of laparoscopic common bile duct exploration has become more and more common.In clinical practice,there are often patients who receive reoperation or even multiple operations to treat choledocholithiasis.However,for patients with choledocholithiasis who have had a history of abdominal surgery,there is some controversy about whether laparoscopic common bile duct exploration is the most effective and safe treatment.Therefore,the purpose of this study was to explore the clinical value of laparoscopic common bile duct exploration in patients with abdominal reoperation,and to make a comprehensive comparison with open common bile duct exploration.Materials and methodsFrom March 2015 to May 2016,laparoscopic common bile duct exploration(LCBDE group)and open common bile duct exploration(OCBDE group)were performed in Zhengzhou University people’s Hospital for choledocholithiasis.The medical records of patients with history.The general data,common bile duct diameter,operative bleeding volume,operation time,fasting time,postoperative hospital stay,average hospital stay and hospitalization cost between LCBDE group and OCBDE group were compared.The incidence of postoperative biliary fistula,high fever,abdominal distension,abdominal pain,pulmonary infection,incision infection and residual stones were compared between the two groups.The percentage of neutrophils(NEU%),C-reactive protein(CRP)and other inflammatory stress related indexes were compared between the two groups at 1 day after operation.The percentage of neutrophils(NEU%)and C-reactive protein(C-reactive protein)at 3 and 7 days after(WBC),operation were compared between the two groups.When GraphPad Prism 5.0software(GraphPad Software)was used for statistical analysis,when P < 0.05,the difference was considered to be statistically significant.ResultsThe estimated blood loss,hospitalization cost,fasting time,postoperative hospital stay and average hospital stay in LCBDE group were significantly lower than those in OCBDE group(P < 0 05).There was no significant difference in WBC,NEU% and CRP between LCBDE group and OCBDE group(1 and 7 days after operation).There was no significant difference in the operation time between the two groups,but the preoperative days in the LCBDE group were significantly longer than those in the control group(P < 0 05).There was no perioperative death in both groups,and there was no conversion to laparotomy in LCBDE group.Bile fistula occurred in 2 of 31 patients in LCBDE group(6.4%)(5 of 69 patients in 2-31);OCBDE group).The incidence of bile fistula was 7.2%(5-69).There was no significant difference in the incidence of high fever,abdominal distension,abdominal pain,pulmonary infection and residual stone complications between LCBDE group and OCBDE group.Only one patient in OCBDE group developed incision infection.All patients with postoperative complications were not reoperated,but improved or cured after conservative or interventional treatment.There was no significant difference in postoperative complications between the two groups(χ 2 = 0.2953).ConclusionLCBDE can be a safe and feasible surgical method for patients with a history of abdominal surgery.LCBDE operation reduces the amount of intraoperative blood loss,shortens the postoperative fasting time and hospital stay,reduces the cost burden of patients,improves the quality of life of patients after operation,and the overall therapeutic effect may be better than that of OCBDE.The key difficulty of the operation is to carefully separate the adhesion and clearly expose the common bile duct,and to remove the stones by various methods.