Clinical Research Of Primary Closure Of Common Bile Duct Wound Treatment Of Secondary Common Bile Duct Stones And Interventional Effect Of Dachaihu Decoction

Objective: Through the comparison of the common bile duct exploration, primary bile duct closure and T-tube drainage for the treatment of secondary common bile duct stones to evaluate the safety and reliability of common bile duct exploration and closure operation.To establish the common bile duct exploration and primary suture in the treatment of secondary common bile duct calculi’s operation indication, contraindication and the technical specification, and popularizing this technique in biliary surgical counterparts.Methods: The extrahepatic biliary calculi were treated by the need for common bile duct exploration of patients according to the need of disease were divided into 3 groups from Jan.2006 to Jun. 2014 in department of hepatobiliary surgery, one group received the treatment of common bile duct exploration and primary suture, other group received the treatment of common bile duct exploration and T-tube drainage, the others group received the treatment of ERCP and EST. We compared 3 groups of patients with the time of hospitalization, cost of hospitalization, postoperative complications, liver function test results and the average volume of fluid infusion during hospitalization, and finally evaluated the postoperative changes of morphology by follow-up after operation with underwent MRCP or BUS examination.Results: There were 365 cases in the group of common bile duct suture, a total of 5 cases of postoperative abdominal drainage fluid containing bile, after continuous drainage in 3 ~ 8 days the bile was disappear without any special treatment. There was no complications in the common bile duct suture group. In the T-tube drainage group that a total of 22 cases of abdominal drainage fluid containing bile after the operation, drainage in 2 ~ 7 days the bile was disappeared. A total of 621 cases in the T tube drainage group, There are 5 cases got the bile peritonitis when the T-tube was removed after the operation of 18, 21, 23, 28 days, 3 cases accepted operation again, 1 case that along the T tube sinus reset T-tube drainage and the symptomatic improvement after that treatment, 1 case through the duodenal endoscopy placed BD tube drainage and along the T-tube sinus placed the abdominal drainage and after the symptomatic treatment the symptoms was remission. ERCP, EST, stone extraction group a total of 145 cases, after the operation a total of 62 cases of patients with varying degrees of hematuria/urine amylase increased, after symptomatic treatment for 1 to 2 days to resume normal, 2 cases got severe acute pancreatitis with peritoneal effusion of necrotic foci and alleviate with the puncture drainage and symptomatic treatment. 2 cases of hemorrhage of digestive after operation, 1case accepted endoscopic hemostasis, 1 case were relieved by symptomatic treatment. Nobody dead in Peri operation period. In exploration of the common bile duct suture group, the postoperative infusion volume, normal eating time and postoperative hospital stay were significantly shorter than the T-tube drainage group(P<0.05). Close to the ERCP endoscopic therapy group. Exploration of the common bile duct suture group’s postoperative complication rate was significantly lower which compared to the other two groups. The total cost of hospitalization and the average cost of the primary suture group were lower than the other two groups. In about 3 months after operation, 3 groups of patients went to the outpatient to check abdominal ultrasound, If able to do check the MRCP, no one got the residual bile duct stones. Long term postoperative follow up of 1 ~ 3 years, patients in common bile duct primary suture group without the occurrence of stricture of bile duct and bile duct stones. T-tube drainage group of 5 cases during follow-up revealed the presence of different degree of stenosis of bile duct. All of the narrow part were at the position of the T-tube drainage, and these patients were accepted reoperation treatment. The operation mode was the bile duct shaping silicone T tube drainage. 11 patients for 10 ~ 36 months post operation recurrent common bile duct stones whose accepted the treatment of endoscopic stone extraction. There were 5 cases in group ERCP respectively after 1 years, 2 years of recurrent common bile duct stones, and all them accepted the treatment of endoscopic stone extraction.Conclusions: 1.Under the strict control of operation precondition and contraindication disease, the common bile duct exploration and primary suture in the treatment of secondary common bile duct stones is safe and reliable mode of operation.2.Common bile duct exploration and primary suture in comparison to the traditional T-tube drainage has the less trauma, lower incidence of postoperative complications, shorter hospital stay, medical cost is low, the advantages of quick recovery in patients and the postoperative pain is small. 3.Common bile duct exploration and primary suture in contrast to endoscopic retrograde biliary stone extraction technique has the advantages of simple operation, low requirements of the technical conditions, without disrupting the normal bile duct physiological structure, low treatment cost, convenient advantages widely in the basic level hospital. At the same time, avoid the acute pancreatitis induced by endoscopic operation and hemorrhage of upper digestive tract and other serious complications and biliary reflux, stone recurrence risk.