Improve The Effect Of Laparoscopic Common Bile Duct Exploration Stone Extraction For Evaluation

Object:Through the improvement of laparoscopic common bile duct exploration take stone operation and to reduce intraoperative bleeding, reduce bile duct suture time, reduce the postoperative complications of the patients with common bile duct stones, shorten the course of disease, improve the cure rate. Provide methods for laparoscopic common bile duct exploration application reference basis.Method:124 study objects were selected among the patients who hospitalized in Peace Hospital affiliated to Changzhi Medical College during the period June 2012 to January2016. All the selected patients were diagnosed with common bile duct stones and gallbladder stones by being employed ultrasound and Magnetic Resonance Cholangiopancreatography, and imaging examination showed that they all suffered expansion of the common bile duct to different degree, the diameter of which was all above 1.0 centimeter. Collect the patients' general information( including gender, age, height, weight, waist circumference,smoking history, occupation, living place, culture degree, marriage status, ethnic, blood type). Routine preoperative testing(including blood pressure, red blood cells, white blood cells, platelets, hemoglobin, albumin, creatinine, uric bravery, urea nitrogen,prothrombin time, diameter of common bile duct, common bile duct stones size, number,total bilirubin), coexistent diseases( including hypertension, coronary heart disease,diabetes, respiratory disease, pancreatitis, abdominal surgery history, obstructive jaundice). In the case of informed consent, the patients made their own choices of operation method or agreed to the doctor's decision, then they were randomly divided into two groups(general group and improved group) by simple randomized, 62 cases in each group, the general group undergone conventional laparoscopic common bile exploration during which the surgeon operated on the left side of the patients. As for the patients in the improved group, the operator timely transferred from their left side to their right side during the laparoscopic surgery, using the two auxiliary holes of the right side mainly to suture the common bile duct. The observation indexes:(1) amount of bleeding during intraoperative;(2) the suture time of the common bile duct;(3) the highest temperature of the first three days after surgery;(4) measuring the albumin, total bilirubin three days after the surgery;(5) the recovery time of the gastrointestinal function. All patients were followed up for three months to observe if there's an abdomen pain or presence of biliary tract bleeding or bile leakage or bile duct stricture, the occurrence of residual stone of biliary tract.Results:The 124 patients from the general group and the improved group had all successfully been completed the common bile duct exploration surgery by laparoscopy.1. Two groups of patients were comparable in the gender, age, height, weight, waist circumference, smoking history, occupation, living place, culture degree, marriage status, ethnic, blood type.2. There's no significant difference between blood pressure, red blood cells, white blood cells, platelets, hemoglobin, albumin, creatinine, uric bravery, urea nitrogen,prothrombin time, diameter of common bile duct, common bile duct stones size,number, total bilirubin.3. The coexistent diseases(including hypertension, coronary heart disease, diabetes,respiratory disease, pancreatitis, abdominal surgery history, obstructive jaundice)were comparable because there were no statistical significance(P > 0.05).4. the bleeding during the surgery were( 69.47 ± 16.33) ml &( 62.91 ± 17.66) ml( t=2.148, P=0.034), which were not significantly different, the suturing time of the common bile duct were(7.35 ± 0.69) min &(4.48 ± 1.25) min(t'=15.828 P <0.001); the average highest temperature of three days after surgery were( 38.5 ±0.7) ? &( 37.5 ± 0.6) ?(t=8.541, P<0.01); the average hospital time after surgery were( 9.5 ± 2.9) d &( 7.5 ± 1.8) d(t'=4.614, P<0.05); the function recovery time of the gastrointestinal after surgery between the two groups were [( 2.5± 0.8) d &( 2.0 ± 1.2) d, t'=2.730, P < 0.05 ]; the albumin and total bilirubin were detected postoperative three days, according to the results: compared with the preoperative dates, postoperative albumin increased significantly, the total bilirubin decreased obviously, both return to normal levels, but there's no statistical significance between the two groups(P > 0.05).5. In the first month after surgery: the conventional group had two cases of hemobilia,four cases of bile leakage,four cases of biliary stricture while the improved group had only one case of biliary stricture and two cases of bile leakage. The postoerative complications: the coventional group:16 %(10 / 62), the improved group: 3 %( 2 / 62),the latter one was lower than the formal one, which was statistically significant. In the three months after surery:there happened 21 cases of right epigastric discomfort in the conventional group and 7 in the improved group which was significantly different. None of the two groups of patients had residual calculi in three months after surgery.Conclusions:Modified laparoscopic common bile duct exploration take stone surgery compared with traditional laparoscopic exploration of common bile duct lithotomy reduce bleeding,reduce the bile duct suture time, reduce the postoperative complications of the patients with common bile duct stones, shorten the course of the disease, the relationship of patients after rehabilitation process, improve the cure rate of patients, there is certain clinical value.