The Clinical Research Of Comparison Between Nose Bile Duct Drainage Placed Transabdominal Or Through Mouth In Laparoscopic Surgery

Objective:To compareand analysis of clinical therapeutic effect betweennose bile duct drainage placed transabdominal and through mouth in laparoscopicsurgery, evaluate the safety, feasibility and effectiveness of clinical application of nose bile duct drainage transabdominally in laparoscopic surgery.Methods: Retrospective analysis of 50 patients with gallbladder stones and common bile duct stones in hepatobiliary surgery of Chengdu second People’s Hospital from February 2014 to March 2015, used the laparoscopic cholecystectomy + bile duct exploration+ nose bile duct drainage through mouth+ primary suture(through mouth group); Another 50 patients with gallbladder stones and common bile duct stones from December 2014 to September 2015, used the laparoscopic cholecystectomy+ bile duct exploration+ transabdominal nose bile duct drainage+ primary suture(transabdominal group), compared the clinical data of these two groups of patients. These two groups of patients were treated by the same groups of doctors and used different operative methods, compared the two groups of patients on gender, age, and preoperative liver enzymes, serum bilirubin, common bile duct diameter, number of common bile duct stones, presence of other system diseases, etc. Compared two groups of patients with operation time, intraoperative blood loss, whether to endoscopic sphincterotomy, the time and success rate of place duct, postoperative carminative time, abdominal drainage tube removal time, nose bile duct removal time, hospitalization days, complications, the major complications were acute pancreatitis, bile leakage, duodenal papilla bleeding and biliary infection, then did statistical analysis.Results: These two groups of patients in the gender, age and general situation beforesurgery had no statistical difference(P>0.05), so had comparability. These two groups of surgery were all successful, had no transfer laparotomy cases, no operative deaths cases. The comparison of two groups of patients in the intraoperative blood loss, the success rate of place duct, the abdominal drainage tube removal time, nose bile duct removal time,havd no statistical difference(P>0.05). Operation time of transabdominal group was shorter than through mouth group [(119.22±13.58)min:(131.72±12.01),t=4.876, P=0.000]. The rate of transabdominal group in intraoperative to cut duodend papilla was lower than the through mouth group(χ2=4.006,P=0.045). The transabdominal group was shorter than the through mouth group on the time of place tube [(9.82±2.31)min:(15.04±4.03)min, t=7.800, P=0.000]. The transabdominal group was shorter than the through mouth group at postoperative carminative time [(35.34±4.95)h:(37.46±4.82)h, t=2.170, P=0.032]. The transabdominal group had shorter postoperative hospitalization days than the through mouth group [(6.80±1.36)d:(7.58±1.76)d, t=2.481, P=0.015]. The post-operative complication rate of the transabdominal group was lower than the through mouth group(χ2=4.000, P=0.046).Conclusions:Nose bile duct drainage placed transabdominal in laparoscopic surgery can effectively improve the safety of the primary suture, and makes a shorter operation time, place tube operation more convenient, and can significantly reduce the proportion of endoscopic sphincterotomy, reduce the stimulation of gastrointestinal incurred, gastrointestinal function of patients can recover as soon as possibleafter surgery, as well as can effectively reduce the incidence of postoperative complications. It is a safe, effective and feasible operative type, which has a great clinical application value.