The Application Of Percutaneous Transhepatic Biliary Drainage Combined With Intraoperative Cholangiography And Water Injection Test In Primary Suture Of Laparoscopic Biliary Exploration

Objective:By comparing the clinical data of patients who underwent primary suture in laparoscopic bile duct exploration with preoperative retained percutaneous transhepatic cholangial drainage and underwent intraoperative cholangiography and water injection test by percutaneous transhepatic cholangial drainage with those who underwent primary suture in laparoscopic bile duct exploration with only retained percutaneous transhepatic cholangial drainage,To analyze whether cholangiography and water injection test by percutaneous transhepatic cholangial drainage can further reduce the incidence of postoperative complications and improve the minimally invasive treatment effect on the basis of primary suture in laparoscopic bile duct exploration.Methods:According to strict inclusion criteria,the clinical data of patients with gallstones and extrahepatic bile duct stones admitted to our hospital were collected from September 2016 to December 2018.The group patients had acute cholangitis or severe obstructive jaundice at admission,and needed biliary decompression and drainage,They don’t have the contraindications of percutaneous transhepatic cholangial drainage.All patients underwent percutaneous transhepatic cholangial drainage under the guidance of ultrasound 1-3 days after admission.Laparoscopic cholecystectomy combined with common bile duct exploration and lithotripsy were performed,and primary suture of common bile duct was performed during the operation.According to whether or not underwent intraoperative cholangiography and water injection test,the patients were divided into experimental group and control group,the experimental group underwent cholangiography and water injection test by percutaneous transhepatic cholangial drainage on the basis of primary suture of common bile duct,while the control group only underwent primary suture of common bile duct.General data of each group were collected,including sex,age,complications,the number of bile duct stones,the diameter of common bile duct,whether the patient suffer from cholangitis and liver function at preoperative.And collect the date of the Surgery-related information,the liver function at the third day after operation,the complication,the hospital stay and the hospitalization expenses.The SPSS 21.0 software package was used for statistical analysis of relevant experimental data.If the P-value was less than 0.05,the difference was significant.If the P-value is more than 0.05,the difference was not significant.Results:The total of 126 patients,whoes aged 20-69 years and including 46 males and 80 females were collected.There were 64 cases in the experimental group and 62 cases in the control group.There were 126 cases with successful surgery and no cases of conversion to laparotomy,serious complications or death after operation,and no cases of re-exploration of abdominal cavity.In the experimental group,no residual stones were found by intraoperative cholangiography,no residual stones or biliary strictures were found by postoperative reexamination,and no bile leakage was found after operation,only 4 cases were complicated with cholangitis.In the control group,3 cases had residual stones,7 cases had bile leakage and 5 cases had cholangitis after operation.The clinical data of the two groups were analyzed and compared.The results showed that there was no significant difference in the general data before operation between the two groups,the P-value is greater than 0.05;there was no significant difference in the liver function indexes on the third day after operation between the two groups,the P-value is greater than 0.05;there was no significant difference in the incidence of residual stones,biliary stricture and cholangitis between the two groups,the P-value is greater than 0.05;while the incidence of biliary leakage and total complications in the experimental group were far lower than those in the control group,the difference between the two groups was statistically significant,the P-value is less than 0.05;the length of stay and hospitalization expenses in the experimental group were lower than those in the control group,and the difference between the two groups was statistically significant,the P-value is less than 0.05.Conclusions:The first conclusion is that percutaneous transhepatic cholangial drainage is conducive to control infection and recovery liver function in patients with extrahepatic bile duct stones complicated with cholangitis or severe obstructive jaundice,it can not only avoid the indwelling of T-tube,but also improve the recovery of liver function.The second conclusion is that intraoperative cholangiography through percutaneous transhepatic cholangial drainage tube can detect residual stones in time,reduce the risk of re-operation or endoscopic lithotomy for residual stones after operation,and it have positive significance in preventing postoperative biliary stricture caused by suture technique.The third conclusion is that intraoperative water injection test through percutaneous transhepatic cholangial drainage tube can verify the occurrence of bile leakage under high biliary pressure timely,check the suture quality,and reduce the incidence of bile leakage after operation.