A Comparative Study Of PTCD And ENBD External Drainage In Primary Closure Of LCBDE

Objective:By retrospectively analyzing the clinical data of patients with cholecystolithiasis with choledocholithiasis,the clinical efficacy and respective advantages and disadvantages of PTCD and ENBD external drainage methods in primary closure of laparoscopic biliary exploration were compared,so as to provide basis and reference for clinicians in the selection of the two surgical methods.Methods:Clinical data of 71 patients with cholecystolithiasis with common bile duct stones admitted to the Department of Hepatobiliary Surgery of the Second Affiliated Hospital of Kunming Medical University from September 2017 to September 2020 were collected.Patients were divided into two groups according to different surgical methods after admission:In PTCD group,34 patients were treated with laparoscopic cholecystectomy+biliary duct exploration and primary closure+PTCD(LC+LCBDE+PTCD).In ENBD group,37 patients were treated with laparoscopic cholecystectomy+biliary exploration and primary closure+endoscopic nasobiliary drainage(LC+LCBDE+ENBD).The preoperative general data,operative time,intraoperative blood loss,postoperative ventilation time,postoperative indwenting time of abdominal drainage tube,postoperative hospital stay,incidence of postoperative complications,hospitalization cost and other indexes of the two groups were statistically analyzed,and the differences between the two surgical methods were compared.SPSS 24.0 software was used to process the data,and P<0.05 was considered statistically significant.Results:1.Preoperative data Statistical analysis results showed that there were no significant differences in gender,age,prevalence of basic diseases(hypertension,diabetes,coronary heart disease)between the two groups(P>0.05),and there were no significant differences in preoperative common bile duct diameter,stone number,maximum stone diameter and preoperative liver function between the two groups(P>0.05).The results showed that the postoperative data of the two groups were comparable.2.Intraoperative dataThe mean operation time of the PTCD group was 175±27min,and the mean operation time of the ENBD group was 209±45min.The difference in the operation time between the two groups was statistically significant(P=0.001),and the operation time of the PTCD group was significantly shorter than that of the ENBD group.There was no significant difference in intraoperative blood loss between the two groups(P>0.05).3.Postoperative dataThere were no significant differences in postoperative ventilation time,abdominal drainage time and postoperative hospitalization time between the two groups(P>0.05).In the comparison of hospitalization expenses between the two groups,the hospitalization expenses of patients in the PTCD group were 26188±3395 yuan and those in the ENBD group were 31224±3997 yuan,and the difference between the two groups was statistically significant(P=0.001).The hospitalization expenses of patients in the PTCD group were significantly lower than those in the ENBD group.The complication-related comparison results between the two groups showed that there was no statistical significance in the incidence of postoperative bile leakage,postoperative stone residual,postoperative cholangitis,postoperative pancreatitis and postoperative total complications between the two groups(P>0.05).Conclusion:1.LC+LCBDE+ENBD primary closure and LC+LCBDE+PTCD primary closure are both effective methods for the treatment of cholecystolithiasis with choledocholithiasis,which should be selected reasonably according to their indications in clinical practice.2.LCBDE primary closure combined with nasobile duct drainage is suitable for patients without preoperative bile duct dilation,and intraoperative nasobile duct angiography is beneficial to reduce the possibility of postoperative stone residue.3.LCBDE primary closure combined with PTCD tube drainage is suitable for patients with preoperative bile duct dilation and indwelling PTCD tube.Compared with nasobiliary tube drainage,the operation time is shorter and the hospitalization cost is lower.