Experience Discussion Of Preoperative Nasobiliary Drainage In Difficult Laparoscopic Cholecystectomy

Objective:To investigate the safety and efficacy analysis of endoscopic nasobiliary drainage(ENBD)was performed preoperatively in difficult laparoscopic cholecyste-ctomy.Methods:The clinical data of patients with difficult gallbladder diagnosis and concurrent laparoscopic cholecystectomy admitted to our hospital from January 2016 to May2020 were retrospectively studied.The patients with difficult gallbladder were divided into two groups: the nasobiliary duct group and the non-nasobiliary duct group.The nasobiliary duct group was placed by retrograde endoscopic cholangiopantratography before LC,while the non-nasobiliary duct group was routinely treated with LC without nasobiliary duct drainage before LC.The general data of patients in the two groups were compared,and the operative time,intraoperative blood loss,length of hospital stay,conversion rate of laparotomy,intraoperative common bile duct injury rate and incidence of postoperative bile leakage in the two groups were compared,and statistical analysis was conducted.Results:A total of 183 patients were included in the two groups,including 91 patients in the nasobiliary duct group and 92 patients in the non-nasobiliary duct group.The general data of the two groups were comparable.Compared with the non-nasobiliary duct group,the operative time [80(67-105)minutes vs 93(76.25-137.25)minutes,P=0.01],the rate of conversion to laparotomy [1.1% vs 8.7%,P=0.04] and the incidence of bile leakage [0% vs 8.7%,P=0.012] were all reduced in the nasobiliary duct group,with statistically significant differences(P < 0.05),while there were no statistically significant differences in the amount of intraoperative blood loss,length of hospital stay and the rate of bile duct injury between the two groups(P > 0.05).Conclusion:Before difficult laparoscopic cholecystectomy,ENBD is an effective and feasible plan,which can effectively shorten the operation time,reduce the conversion rate of laparotomy,and reduce the occurrence of serious complications of biliary surgery,especially in the laparoscopic cholecystectomy of Mirizzi syndrome and frozen gallbladder triangle.