Prospective Study On Feasibility Of Laparoscopic Choledocholithotomy And Primary Suture In Treatment Of Choledocholithiasis

Backgroud and objective：80in the French doctor PhillipeMouret performed thelaparoscopic cholecystectomy (laparoscopic cholecystectomy,LC), LC has the advantages of small trauma to patients, fasterrecovery, less pain, good cosmetic effect rapidlypopularization, promotion and development. Has now become thegold standard for the treatment of simple gallbladder stones,gallbladder polyp "". In1889the Swiss LUDWIG COURVOISIER thesuccessful implementation of the first opencholedocholithotomy, since the operation has been the standardprocedure in the treatment of common bile duct stones. With thepopularity of laparoscopic technique in the field of surgery,the most open, operation can be finished by laparoscopicoperation. Enter90age, the vigorous development oflaparoscopic techniques, the developed LC surgery,laparoscopic choledocholithotomy (laparoscopic common bileduct exploration, LCBDE), combined three endoscopes in Calculus of common bile duct operation. In recent years, isapplied to the treatment of common bile duct stones, bile ductstones. And achieve good effect, placing T in choledochotomytube drainage has become a routine, but placed T tube has manydisadvantages, such as placing a long time, extubation withbile leakage, biliary peritonitis may. In recent years, withthe development of minimally invasive techniques and graduallymature, surgical treatment of common bile duct stones and tothe development of endoscopic sphincterotomy and laparoscopiccommon bile duct choledochoscopic lithotomy, the latterbecause it does not damage the duodenal papillary sphincter,gallbladder and common bile duct to solve the problem, by thepatients welcome." Huang Zhiqiang " is a surgical incision andexploration of laparoscopic common bile duct suture operationworks, as technology improves, part of the medical institutionsat home and abroad in laparoscopic common bile duct lithotomy," selective implementation of primary suture of common bileduct T tube drainage base ", in the developed area of our country,has completed the tens of thousands of cases in2008, ourprovince is also part of the completion of the operation ofhospital and reports, has good effect, cut stone and primarysuture of laparoscopic common bile duct, with less trauma, less bleeding, postoperative pain, shorter hospital stay, patientsare easy recovery, less complications. Selective laparoscopicexploration of common bile duct lithotomy primary suture issafe and feasible. For patients with bile duct stones will bringmore benefits. Therefore, whether it is traditional openoperation and laparoscopic operation, common bile ductlithotomy directly after the suture and T tube drainage,clinical controversial, the traditional idea that the T tubedrainage can effectively reduce the pressure of biliary tract,promote recovery, but T tube bile large amount loss, causingelectrolyte and digestive dysfunction in addition, patientswith T tube indwelling acceptance is low. So I choose thisschool and hospital of Jilin province from avant-garde inpatients with choledocholithiasis, were open and laparoscopicoperation stone with a suture or T tube drainage treatment,explore the feasibility of laparoscopic common bile duct stoneafter direct suture.Methods：120patients with choledocholithiasis admitted to ourhospital were randomly divided into four groups according toprospective study methods,with30patients in each groups.patients of group A were given laparoscopic choledocholithotomy and primary suture treatment, patients ofgroup B were given laparoscopic choledocholithotomy and T tubedrainage treatment, patients of Group C were treated withLaparotomy choledochostomy and primary suture treatment，patients of Group D were treated with Laparotomycholedochostomy and T tube drainage treatment. The operativesituation, the postoperative recovery and complications offour groups were analyzed and compared.Results：The postoperative hospital stay, intestinal functionrecovery time of group A, group B is significantly shorter thanthe Group C and Group D, these indicators of group A weresignificantly better than group B, the differences werestatistically significant(P<0.05); operative time, blood lossof group A and group B was significantly different from groupC and group D (P <0.05), the difference between group A andB, group C and D was not statistically significant (P>0.05);the incidence of bile leakage in group A and group C wassignificantly less than group B and group D (P <0.05), theother incidence of complications was not significantlydifferent (P>0.05). Conclusion：Laparoscopic choledocholithotomy in treatment ofcholedocholithiasis has the advantage of less damage, rapidpostoperative recovery, and safety and efficacy oflaparoscopic choledocholithotomy and primary suture are better,it can avoid the complications caused by T-tube drainage, sois worthy of application.