Clinical Research Of Laparoscopic Transcystic Exploration For Patients With Common Bile Duct Stones

Objective:To evaluate the clinical results of laparoscopic transcystic common bile duct exploration(LTCBDE)for patients with common bile duct stones.Method:Retrospected and analyzed clinical documents of 119 patients with common bile duct stones in our hospital from September 2012 to October 2015,According to their modus operandi was divided into two groups,the research group underwent laparoscopic transcystic common bile duct exploration(57 cases),the control group received laparoscopic common bile duct exploration with T-tubc drainage(62cases).The Success rate of surgery,conversion to open surgery,operative time,postoperative drainage tube placement time,postoperative anal exhaust time,back to Normal life time and incidence of complications were evaluated.Results:1.General situation and clinical data: there was no significant difference in terms of gender,age,common bile duct diameter,the number of stones between the two groups of patients,and the clinical data of two groups were comparable(P>0.05).2.Surgical results: In this study,all patients are successful operation with no operative deaths.There are eight patients diverted bile duct stone with T tube drainage because the gallbladder tube is meticulous,too short,distortion caused by hand transcystic duct exploration failure,and three patients converted to laparotomy result in the gallbladder,common bile duct,inflammatory edema heavier,unable to identify the cystic duct and common bile duct.The take stone surgery success rate of the research group is 46 / 57(80.7%),the rate of laparotomy is 3/57(5.3%).There are four patients converted to laparotomy because of gallbladder and common bile duct,inflammatory edema heavier too?The surgical success rate of the control group is 58 /62(93.5%),the rate of conversion to laparotomy is 3/62(6.5%).There were nosignificant difference in surgical success rate and conversion to open abdominal rate between the two groups(P>0.05).3.Operation and postoperative conditions: the research group was less than the control group in operation time,postoperative drainage time,postoperative first anal exhaust time,recovery of normal time and hospital total cost,the difference is statistically significant(P < 0.05),in the recovery of normal time has obvious advantages.4.The complications and follow-up results : There are four cases appeared complications in the research group,two cases was bile leakage,two cases was residual stones,the complication rate was 7%;The control group appear ten cases of complications,including one patients with gallstone recurrence after two years,one patients with stones the residual,two cases of bile leakage after surgery,two patients with bile leakage after removal of T tubes,two cases with T tube early fall off,one cases with biliary tract hemorrhage,and one patients with cholangitis,the complication rate was 16.1%;To the statistical analysis,the two complication rate compared with the difference was not statistically significant(P>0.05).There were no biliary stenosis,no significant difference between the long-term efficacy between the two groups in all the patients.Conclusion:By comparative study,laparoscopic transcystic common bile duct exploration(LTCBDE)is a safe and effective operation that compare with laparoscopic common bile duct exploration with T-tubc drainage had no significant difference in the long term effects,and the postoperative recovery state has obvious advantages,as long as indications accurately grasp,choosing the suitable cases,the treatment is worth popularization and application.