Analysis Of Clinical Application Of Ultra-fine Choledochoscopy In Bile Duct Exploration And Lithotomy Through Cystic Duct

Objective:1.Safety,feasibility and effectiveness of using ultra-fine choledochoscopy in choledocholithotomy through cystic duct.2.To explore the surgical effect of laparoscope combined with ultra-fine choledochoscopy choledocholithotomy through cystic duct,and compare it with laparoscopy combined with endoscopic lithotomy at the same time,and analyze the advantages and disadvantages of the two surgical methods.Whether it is worthwhile to popularize the application of ultra-fine choledochoscopy in clinic.3.To explore the application prospect of using ultra-fine choledochoscope to remove choledocholithiasis in patients with secondary choledocholithiasis without common bile duct dilatation.Method:This study adopted the method of retrospective analysis,combined with the data of 118 patients who underwent laparoscopic cholecystectomy combined with choledocholithotomy in our hospital from September 2018 to December 2020.According to the different operative methods and strictly according to the corresponding criteria,the patients were divided into two groups:ultra-fine group(n=48)and endoscopy group(n=70).In the ultra-fine group,the operation position was placed and the pneumoperitoneum pressure was controlled,the gallbladder triangle was dissected and the gallbladder artery was severed by biological clamp and electrocoagulation,and the distal cystic duct was clipped by biological clamp,opening the cystic duct and inserting ultra-fine choledochoscope and net blue to remove the stone.In the process of stone extraction,if the stone is stuck in the common bile duct confluence part of the cholecystic duct,the confluence part can be micro-cut,and the bile duct stone can be removed exactly.Finally,cut off and closed the cystic duct or sutured the confluence of the cystic duct and common bile duct,take out the gallbladder and stone specimens,place a suitable abdominal drainage tube in the celiac gallbladder fossa area,count the instruments and gauze used in the operation,and close the posting mouth in the corresponding position.In the endoscopic group,the proper abdominal drainage tube was placed in the laparoscopic cholecystectomy,celiac gallbladder fossa under routine general anesthesia,the Oddi sphincter was cut open through the mouth under duodenoscope,the biliary calculi were removed by balloon dilator and stone net basket,and the nasobiliary duct was retained in the bile duct for external drainage and fixation.The case data collected from the two groups were collected,including:(1)general data before operation,relevant laboratory biochemical indexes(alanine aminotransferase ALT,aspartate aminotransferase AST,gamma-glutamyl transferase GGT,alkaline phosphatase ALP,total bilirubin TBIL,direct bilirubin DBIL,indirect bilirubin IBIL,white blood cells WBC,hemoglobin HGB),imaging results;(2)intraoperative statistical indicators:surgical bleeding volume,operation time.(3)laboratory indexes on the first day after operation(alanine aminotransferase ALT,aspartate aminotransferase AST,gamma-glutamyl transferase GGT,alkaline phosphatase ALP,total bilirubin TBIL,direct bilirubin DBIL,indirect bilirubin IBIL,white blood cells WBC)and related complications;(4)postoperative hospital stay,abdominal drainage tube extubation days,total hospitalization cost and other economic indicators.After the two groups of data were collected and sorted out,the preoperative data were compared and analyzed by SPSS25.0 software package to verify whether the two groups of data were comparable,and to further explore whether there were statistical differences in intraoperative data and postoperative related data.Results:The operation was successful in 118 cases and there was no death.There were significant differences in operation time,postoperative hospital stay,total hospitalization cost,pancreatitis and total complications between the two groups(P<0.05).The ultrafine group was lower than that in the endoscopy group.There was no significant difference in surgical bleeding volume,laboratory related indexes on the first day after operation(ALT,AST,GGT,ALP,TBIL,DBIL,IBIL,WBC),days of extubation of abdominal drainage tube,occurrence of residual stones,bile leakage,biliary stricture,reflux cholangitis and intestinal perforation between the two groups.However,the analysis and comparison of the data of the two groups showed that the incidence of reflux cholangitis in the ultra-fine group was significantly lower than that in the endoscope group(0%vs 5.7%).Conclusions:1.Laparoscope combined with ultra-fine choledochoscopy is safe,feasible and effective in bile duct lithotomy.2.The function and structure of Oddi sphincter were completely preserved by ultra-fine choledochoscopy to avoid the occurrence of T-tube indwelling and many adverse complications such as pancreatitis and reflux cholangitis.3.Choledocholithotomy with laparoscope combined with ultra-fine choledochoscopy not only reduces the operation time of patients,but also has shorter postoperative hospital stay,faster recovery and lower hospitalization cost.