The Clinical Follow-up Of Patents Who Received Operation That Laparoscopic Combined With Choledochoscope To Gallbladder Retention

Objective:To investigate recurrence of gallstones after laparoscopic and choledochoscopiclithotomy combined with gallbladder preservation and analyse the postoperative recurrence factors,explore the practicability and safety of this surgical approach.Methods:175 patients were gathered from 497 patients that on the basis of the clinical including criteria with cholelithiasis remedied in Jinshan Hospital General Surgery which is the First Affiliated Hospital of Chongqing Medical University, and blocked sort into gallbladder preservation group(78cases)and LC group(97cases). Patients who received the gallbladder retention surgical were followed up and dissect the recurrence rate and factors related to minimally invasive gallbladder preservation lithotomy. And compare the two groups of duration of operation,intraoperative hemorrhage,anal evacuation time,length ofstay,complications,etc.Results :Patients who received the Gallbladder Retention surgical were followed up and the total amount is 64 cases. Followe-up rate is82.1%(64/78),follow-up time is 6 ~ 39 months, in all cholelithiasis recurrence rate was 18.8%(12/64), Single cholelithiasis recurrence rate was3.1%( 2/64),pilosity cholelithiasis recurrence rate was 15.6%(10/64).Unitivariate analysis it turned out that the pilosity cholelithiasis,preoperative symptoms, postoperative whether take bear to oxygen cholic acid, duration of operation,the gallbladder wall stones and cholelithiasis recurrence were significantly related( P < 0.05), had statistical significance.The factors that unitivariate analysis it turned out had statistical significance is the duration of operation(P=0.031 EXP(B)=13.789) pilosity cholelithiasis( P = 0.012 EXP(B) = 11.759), the gallbladder wall stones(P=0.013 EXP(B)=29.663)were confirmed of cholelithiasis recurrence risk factors.Two groups of comparison, the time of gallbladder preservation group of duration of operation is longer than the LC group(P<0.05),had statistical significance,two groups of intraoperative hemorrhage,evacuation time,length of stay(P>0.05)had no obvious statistical significance.All two groups patients no surgical complications for instance biliary injury, bile leak, secondary choledochotithiasisi etc.Conclusion :In comparison with ntraoperative hemorrhage,evacuation time,length of stay in gallbladder preservation group and LC group, there wsa no evident difference, all the operations are done very well, without complications.The way link up laparoscopic with choledochoscopiclithotomy in Gallbladder Retention surgery is a practicability and safety surgical approach. But after tthe operation that link up laparoscopic with choledochoscopiclithotomy in gallbladder preservation,the cholelithiasis recurrence is above the average, operation time is too long,the cholelithiasis with gallbladder wall stones,pilosity cholelithiasis,are the risk factors for cholelithiasis recurrence. Patients with pilosity cholelithiasis or the cholelithiasis with gallbladder wall stones should to approach with prudence on gallbladder- preserving surgery, shorten the operation time is the key to avoid the recurrence of stones.