Comparison Of The Curative Effect Of Choledochal Primary Suture And T-tube Drainage With Double Endoscopy

Objective:To explore the safety and clinical efficacy of the primary suture of in laparoscopic choledocholithotomy with choledochoscopy.Methods:The data of 81 inpatients undergoing laparoscopic choledocholithotomy in the Department of General Surgery of Huainan First People’s Hospital from June 1,2017 to December 31,2019 were selected.Among them,38 patients received primary suture of the common bile duct,and 43 patients received T drainage of the common bile duct.The operative time,intraoperative blood loss,the first day of postoperative bilirubin index,time of first anal ventilation,time of postoperative eating,postoperative pain grade,incidence of postoperative complications,time of hospitalization and hospitalization cost of the two groups were compared and analyzed.Results:Patients in both groups received laparoscopic choledocholithotomy combined with choledochoscopy and choledocholithotomy without conversion to open surgery or death.There was no significant difference in general’ data(gender,age,common bile duct diameter,preoperative total bilirubin)between the primary suture group and the T-tube drainage group,and the data of the two groups were comparable.In the primary suture group,the operation time was(127.03±16.44)minutes,total bilirubin index on the first day after surgery was(26.4 ± 6.0)umol/L,direct bilirubin was(14.3±4.5)umol/L,the first anal ventilation time after surgery was(27.32 ± 4.77)hours,postoperative eating time was(1.8±0.5)days,hospitalization time was(8.71 ±1.69)days,and hospitalization cost was(26999±2407)yuan.In the T-tube drainage group,the operation time was(150.70±20.31)minutes,total bilirubin index on the first day after surgery was(38.8±6.5)umol/L,direct bilirubin was(20.7±4.1)umol/L,the first anal ventilation time after surgery was(29.77 ± 4.31)hours,postoperative eating time was(2.3±0.4)days,hospitalization time was(10.00±1.86)days,and hospitalization cost was(28814±3159)yuan.The difference between the two groups was statistically significant(P<0.05).The incidence of biliary fistula and stone residual rate in the primary suture group were better than that in the T tube drainage group,and the difference was statistically significant(P<0.05).There was no statistical significance in intraoperative blood loss and postoperative pain grade between 2 groups(P>0.05).Conclusions:Double endoscopy combined choledocholithotomy and primary suture has significant advantages,which can promote the early recovery of intestinal function,shorten the operation time,reduce the length of hospital stay,save the cost of hospital stay,and also reduce the incidence of postoperative complications.As long as the surgical indications are strictly followed and the operation techniques are skillfully mastered,this operation is safe and feasible,worthy of being widely developed and applied in clinical practice.