Curative Effect Of Laparoscope In Combination With Choledochoscope (Primary Suture) In The Treatment Of Choledocholithiasis Combined With Cholecystolithiasis

Objective: To investigate the curative effect and clinical application value of cholecystectomy +common bile duct exploration+ primary suture under laparoscope in combination with choledochoscope in the treatment of choledocholithiasis combined with cholecystolithiasis. To investigate itsadvantages superior than the traditional laparotomy cholecystectomy + choledocholithotomy + T-tube drainage.Methods: A retrospective contrastive analysis was conducted on choledocholithiasis combined with cholecystolithiasis patients treated by cholecystectomy + common bileductexploration+ primary suture under laparoscope in combination with choledochoscopeand the traditional laparotomy cholecystectomy + choledocholithotomy + T-tube drainage in our hospital from July 2013 to May 2015.Among them, there were 61 patients undergoing traditional laparotomy cholecystectomy + choledocholithotomy + T-tube drainage(laparotomy group) and 54 patients undergoing choledochoscopic cholecystectomy+ common bile duct exploration+ primary suture(minimally- invasive group). The preoperative basic data, intraoperative bleeding, operation time, postoperative hospitalization time, postoperative gastrointestinal function recovery time, postoperative incision infection rate, postoperative bile leakage rate and postoperative residual stone rate were statistically analyzed.Result: The operations were successful in two groups.(1) Intraoperative bleeding: The intraoperative bleeding in the minimally- invasive group(34.44±4.593ml) was less than that of the laparotomy group(138.9±19.77ml),which was significantly different P <0.0001;(2) Operation time:There was no statistical significance in the operation time between thelaparotomy group(113.4±4.095min) and minimally- invasive group(115.6±3.971min), P=0.7133;(3) Postoperative hospitalization time: The postoperative hospitalization time in the minimally- invasive group(7.185±0.2213d) was shorter than that of the laparotomy group(11.05±0.6391d), which was significantly different(P <0.05);(4) Postoperative gastrointestinal function recovery time : The recovery time in the minimally- invasive group(38.37±0.7370h) was shorter than that of the laparotomy group(57.10±0.9047h),which was significantly different statistical significance, P <0.0001;(5) Incision infection rate: Theincision infection rate in theminimally- invasive group(1.85%) was less that of the laparotomy group(11.48%), which was significantly different, P =0.0429;(6) Bile leakage rate:There was no statistical significance in the bile leakagebetween the minimally invasive group(3.70%) and laparotomy group(3.28%), P =0.6997;(7) Postoperative residual stone rate: There was no statistical significance between the minimally- invasive group and laparotomy group.Conclusion: C holecystectomy + common bile duct exploration+ primary suture under laparoscope in combination with choledochoscope in the treatment of choledocholithiasis combined with cholecystolithiasis was safety and effective. Compared with traditional laparotomy, T-tube drainage was not required, the surgical trauma was small, the postoperative recovery was rapid, the postoperative hospitalization time was short and the incision infection rate was low. Moreover, the bile leakage rate, residual stone rateand other complications rate were not increased. As long as thesurgical indications, contraindications and operative skills were strictly controlled, the operation was a safe, effective and minimally- invasive, which was worth clinical promotion.