Comparative Study On The Treatment Of Distal Common Bile Duct Stenosis By Progressive Catheter Dilatation And Balloon Catheter Dilatation

Objective: Objective to compare and analyze the perioperative clinical data of laparoscopic progressive catheter dilatation and laparoscopic balloon catheter dilatation in the treatment of distal common bile duct stenosis during laparoscopic common bile duct exploration,and to explore the safety,effectiveness,advantages and disadvantages of the two methods.Methods: A total of 95 patients with cholecystolithiasis,choledocholithiasis and distal common bile duct stenosis admitted to our center from January 2015 to December 2019 were retrospectively analyzed.They were divided into two groups according to the different surgical methods.Among them,50 cases were treated with laparoscopic progressive catheter dilatation for distal common bile duct stenosis,referred to as LPCD group,and 45 cases were treated with laparoscopic balloon catheter dilatation for distal common bile duct stenosis,referred to as LBCD group.The perioperative clinical data of LPCD group and LBCD group were analyzed and compared.Results: There was no significant difference in the gender,age,hypertension,diabetes mellitus,maximum diameter of the common bile duct,maximum diameter of common bile duct stones,number of common bile duct stones(single or multiple),preoperative liver function,preoperative blood amylase and the degree of stenosis between the two groups(P>0.05).There was no significant difference in operation time,intraoperative bleeding between the two groups(P>0.05).The AST difference before and after operation,ALT difference before and after operation,DBIL difference before and after operation,WBC difference before and after operation,PCT difference before and after operation was no significant difference between the two groups.There was no significant difference in the postoperative restenosis and postoperative bile leakage between the two groups(P>0.05).There was significant differences in AMY difference before and after operation,postoperative acute pancreatitis,postoperative nasobiliary duct extraction time,postoperative gastrointestinal symptoms,postoperative gastrointestinal function recovery time and postoperative hospital stay between the two groups(P<0.05).Multivariate logistic regression analysis was performed for postoperative acute pancreatitis,it showed that the degree of distal common bile duct stenosis and the way of stenosis expansion were statistically significant(P<0.05),but the diameter of common bile duct,diameter of common bile duct stones and preoperative PCT value were not statistically significant(P>0.05).Conclusion: The success rate of laparoscopic progressive catheter dilatation and laparoscopic balloon catheter dilatation in laparoscopic common bile duct exploration is high.They are safe and effective to relieve distal common bile duct stenosis.Both of them protect the normal physiological function of Oddi’s sphincter.The postoperative acute pancreatitis and postoperative hospital stay of the LPCD group are less than that of the LBCD group.The postoperative recovery of the LPCD group was faster than that of the LBCD group.