The Clinical Study On Three Methods Of Minimally Invasive Treatment For Cholecystolithiasis With Choledocholithiasis

Objective:This study is to observe the clinical curative effect,including hepatic drainage time、postoperative hospital time、operation expense、bile leakage、acute pancreatitis、residual stones,to compare laparoscopic cholecystectomy primary suture of common bile duct and T-tube drainage with the effects of the combined application of three endoscopes with primary closure.To investigate the value of the effects of the three methods of minimally invasive surgery and provide theoretical basis for the choice of operative methods for the treatment of cholecystolithiasis with choledocholithiasis.Methods:From January 2014 to December 2016,153 patients with cholecystolithiasis with choledocholithiasis in the first affiliated hospital of Da Lian medical university were recruited.According to the way of operation,the patients were divided into three groups:108 patients were treated with laparoscopic cholecystectomy and exploration of common bile duct with T-tube drainage(Group A),31 patients were treated with primary suture of common bile duct in laparoscopic cholecystectomy(Group B),13 patients underwent the combined application of three endoscopes with primary closure(Group C).Patients of group A were treated with laparoscopic cholecystomy,laparoscopic common bile duct exploration and T-tube drainage;Patients of group B were treated with laparoscopic cholecystomy,laparoscopic common bile duct exploration and primary closure;Patients of group C were treated with laparoscopic cholecystomy,laparoscopic common bile duct exploration,endoscopic retrograde cholangiopancreatography,endoscopic nasobibiary,primary closure,.Statistical analysis of the three groups of patients with gender、age、diameter of common bile duct、the number of stones、the maximum diameter of stones and preoperative liver function to prove whether there is comparability.Then,comparing hepatic drainage time 、postoperative hospital time、operation expense、bile leakage、acute pancreatitis、residual stones were contrasted and underwent statistical analyze.Results:1.General clinical data: Gender、age、diameter of common bile duct、the number of stones、the maximum diameter of stones and preoperative liver function between A、B and C is not obvious(P(29)0.05),it showed that there was no significant difference in clinical data and comparable among there groups.2.The postoperative condition:Compared with group A,group B and group C in time of drainage tube 、 time of postoperative hospitalization decreased significantly(P(27)0.05),while there was no significant difference between group B and group C(P(29)0.05).3.The postoperative complications:There was no statistical difference in postoperative bile leakage 、 pancreatitis 、 residual stones and the incidence of postoperative complication among there groups(P(29)0.05).4.Operation costs:The cost of operation in group C was significantly higher than group A and B(P(27)0.05).At the same time,the cost of group A was significantly lower than group B,and there was statistical difference(P(27)0.05).Conclusion:In this study,laparoscopy combined with duodenoscopy and choledochoscopy primary closure is safe 、 effective 、 feasible in the treatment of cholecystolithiasis with choledocholithiasis by comparing the three methods of minimally invasive surgery.They has the advantage of shorter time of drainage and postoperative hospitalization,fewer complications.On the basis of strictly surgical indications 、operating skill and all kinds of hospital hardware and software,the combined application of three endoscopes with primary closure can be used as the frist choice for the treatment of cholecystolithiasis with choledocholithiasis.