Application Of Laparoscopic Biliary Tract Exploration In Recurrent Bile Duct Stones

Background:cholelithiasis,also known as gallstones,refers to the bile duct system,such as:gallbladder or bile duct stone disease.Clinically,cholelithiasis is mainly divided into cholecystolithiasis and cholangiolithiasis according to the different sites of cholelithiasis.With the continuous development of the disease,the gallbladder will produce inflammatory reaction,and when the stone incarcerated in the neck of the gallbladder or the gallbladder duct,there will be secondary infection,resulting in acute inflammation of the gallbladder.At the same time,since the stone continues to stimulate the mucous membrane of the gallbladder chronic,it will increase the incidence of gallbladder cancer.Cholelith disease etiology is very complex.It is generally believed that quiet and little exercise and physique obesity,no breakfast,liver cirrhosis,and genetic factors,and other different factors can effect each other and influence each other.Early onset of clinical symptoms of lack of representativeness,with the continuous development of the illness,will cause pain,muscle tension,abdominal pain,fever,etc.,affect patients’ health and life.At present,the main clinical treatment means is surgical treatment.Although intraoperative calculi have been removed,postoperative calculi recurrence is also relatively common in clinical practice.Therefore,recurrent bile duct calculi and calculi residue have also become common diseases in hepatobiliary surgery.Open again biliary exploration is a common exploration in patients with recurrent bile duct stones,but it has certain risk and trauma.Laparoscopic bile duct re-exploration has the advantages of less surgical trauma,faster postoperative recovery and lower complication rate.Objective:to explore the effect of laparoscopic bile duct re-exploration in patients with recurrent bile duct stones,and to provide basis and reference for clinical treatment.Methods:forty-two patients with recurrent cholangiolithiasis from March 2015 to December 2018 were selected as the objects.All the patients were to undergo surgical exploration.They were divided into the laparotomy group(n=17 cases)and the laparoscopic group(n=25 cases)according to different surgical methods.Laparotomy group adopts open again for the treatment of bile duct exploration intervention,the laparoscopic group for the treatment of laparoscopic bile duct exploration again intervention,to evaluate 3 d effect on the patients after treatment,postoperative 12 months of follow-up in both groups,compared two groups of operation indicators(including:operation time,hospitalization fee for the first time,intraoperative blood loss,postoperative exhaust and postoperative hospital stay,postoperative recovery time of gastrointestinal tract),biochemical index levels(including:c-reactive protein(CRP),neutrophil percentage,white blood cell count(WBC)level),bile and biochemical indexes,liver function level,the incidence of postoperative complications(including:Abdominal pain,incision infection,bile leakage,high fever and abdominal distension),residual stone rate,recurrence rate.All data in this study were processed by SPSS18.0 software.Results:(1)the operation time,hospital expenses,intraoperative blood loss,postoperative first exhaust,postoperative hospital stay and postoperative gastrointestinal recovery time of the laparoscopic group were all shorter(less)than that of the laparotomy group(P<0.05).(2)the 3d CRP,percentage of neutrophils and WBC levels in the two groups after surgery were lower than those before surgery(P<0.05).CRP,percentage of neutrophils and WBC levels in the laparoscopic group were lower than those in the laparotomy group(P<0.05).(3)the levels of 3d TBA,TBiL,DBiL and IBiL in the two groups after surgery were lower than those before surgery(P<0.05).The levels of 3d TBA,TBiL,DBiL and IBiL in the laparoscopic group were lower than those in the laparotomy group(P<0.05).(4)after surgery,the levels of AST,ALT and r-gt in the two groups were lower than before surgery(P<0.05).The levels of AST,ALT and r-gt in the laparoscopic group were lower than those in the laparotomy group(P<0.05).(5)the incidence of postoperative abdominal pain,incision infection,bile leakage,high fever and abdominal distension in the laparoscopic group and the laparotomy group was not statistically significant(P>,0.05).(6)there was no significant difference in the residual stone rate and recurrence rate between the two groups one month after surgery(P>,0.05).The rate of residual stones at 6 months and 12 months after operation between the laparoscopic group and the laparotomy group was not statistically significant(P>,0.05).The recurrence rate of the laparoscopic group at 6 months and 12 months after surgery was lower than that of the laparotomy group(P<0.05).Conclusion:laparoscopic re-exploration of the biliary tract for patients with recurrent bile duct stones can achieve good results,with the advantages of less surgical trauma,less postoperative bleeding,and can speed up the recovery of patients;It can reduce the level of inflammatory factors,improve the level of bile and liver function,and also reduce postoperative complications,residual stone rate and postoperative recurrence rate.