The Analysis Of The Clinical Application Of Laparoscopic Bile Duct Suture

Objective: To retrospective analysis the effects of primary duct closure comparative with T-tube drainage and endoscopic retrograde cholangiopancreatography(ERCP) after laparoscopic cholecystectomy(LC) in laparoscopy choledochotomy to treat the cholecystolithiasis with choledocholith.Methods:The clinical data of 135 patients with cholecystolithiasis with choledocholith from February 2014 to November 2015 treated with laparoscopic choledochotomy were retrospectively analyzed. Of the 135 patients, 40 cases underwent primary closure(suture group), 36 cases received T-tube drainage(drainage group) and 59 cases received ERCP+LC(ERCP+LC group) after treat by laparoscopic common bile duct exploration(LCBDE) or ERCP.The operation time,duration of hospital stay, hospital cost, operation cost, intraoperative bleeding, postoperative bilirubin recovery, postoperative complications and again returned to the hospital were compared between the primary duct closure in laparoscopic choledochotomy group and the other 2 groups.Results: Compared with ERCP+LC group,the primary duct closure in laparoscopic choledochotomy group had shorter operation time, postoperative bilirubin restored to normal time, hospital cost, operation cost and less intraoperative hemorrhage, but the length of hospital stay had no obvious difference; It compared with T tube drainage, the primary duct closure in laparoscopic choledochotomy group had less intraoperative bleeding, but the operation time, hospital cost, operation cost, length of hospital stay and postoperative bilirubin back to normal time has no obvious difference. The incidence of postoperative complications in the primary duct closure in laparoscopic choledochotomy group was 0 case. The incidence of postoperative complications in T-tube group were 4 cases(11.11%).The incidence of postoperative complications in ERCP + LC group were 5 cases(8.47%), the incidence of severe complications that needed reoperations was 0 Complications were caused by T-tube group and ERCP+LC group. Which in the primary duct closure in laparoscopic choledochotomy group again returned to the hospital was 0 case postoperatively, T tube drainage of back court were 23 cases(63.89%), postoperative ERCP + LC group began returning to hospital was 0 cases, returned to the hospital was mainly caused by the postoperative residual stones and the treatment of T tube. Three groups of patients with follow-up results there was no significant difference.Conclusion: The primary duct closure in laparoscopic choledochotomy can avoid a series of disadvantages which caused by T tube and the complications such as pancreatitis caused by ERCP. It has advantages such as fewer complications, faster recovery time, intraoperative bleeding and cost less,so it reflects the superiority of the first phase of the micro surgery.It is safe and feasible that the primary duct closure in laparoscopic choledochotomy treats patients with cholecystolithiasis with choledocholith, so the primary duct closure in laparoscopic choledochotomy is valuable in clinical application.