Clinical Analysis Of Multi-endoscopy Combined Without T-tube Drainage For Treatment Of Extrahepatic Bile Duct Stones

Objective:To compare the clinical efficacy of the study of multi-endoscopy combined treatment of gallbladder stones with choledocholithiasis,including two conventional minimally invasive treatment methods: laparoscopic cholecystectomy combined with laparoscopic choledochotomy(LC + LCBDE),and laparoscopic cholecystectomy combined with duodenoscopy Lithotripsy(LC + ERCP /EST).Among laparoscopic cholecystectomy combined with laparoscopic cholecystectomy,laparoscopic common bile duct exploration without the T-tube drainage was divided into laparoscopic transcystic common bile duct exploration(LTCBDE)and laparoscopic common bile duct exploration and primary suture(LCBDEPS),with T-tube drainage(LCBDETD),to compare the clinical efficacy of the three groups and to discuss the indications and operation skills in laparoscopic cholecystectomy and laparoscopic common bile duct exploration without T-tube drainage.Methods:To collect 80 cases of cholecystolithiasis with choledocholithiasis for minimally invasive surgical treatment in The Second People's Hospital of Wuhu from July 2014 to September 2017,using retrospective clinical research methods,the eligible cases were divided into LC + LCBDE group,a total of 46 cases and LC + EST group,a total of 34 cases.The success rate of operation,operation time,postoperative ventilation time,intraoperative blood loss,postoperative hospital stay,short-term and long-term complications were compared.LC + LCBDE was divided into laparoscopic common bile duct exploration stone without T tube drainage group,including the cystic duct common bile duct exploration(LTCBDE group),a total of 10 cases and a primary suture group(LCBDEPS group),a total of 11 cases and with T tube drainage group(LCBDETD group),a total of 25 cases compared with surgery time,postoperative ventilation time,hospital stay,biliary tract related complications and other indicators.All patients were followed up for 6-12 months.Comparative analysis of the relevant clinical data of patients in each group.Results:Between LC + EST group and LC + LCBDE group,There was no significant difference in age,sex,abdominal pain,fever,jaundice,common bile duct diameter,history of combined abdominal surgery and chronic disease in both groups(all P>0.05).The blood loss,operation time and postoperative ventilation time of LC + EST group were less than LC + LCBDE group,the difference was statistically significant(P<0.05).The success rate of surgery,postoperative pancreatitis,postoperative bile leakage and residual stones,there was no statistically significant difference between the two groups(P> 0.05).Between LTCBDE group,LCBDEPS group and LCBDETD group.There was no significant difference in sex,age,history of chronic diseases and abdominal surgery between the three groups(all P> 0.05).The LTCBDE group and LCBDEPS group were superior to LCBDETD group(P <0.05)in terms of blood loss,operation time,postoperative ventilation time and postoperative hospital stay.The success rate of surgery,postoperative bile duct stones and postoperative bile leakage,the three groups have no significant difference(all P> 0.05).Conclusion:Laparoscopic cholecystectomy with laparoscopic common bile duct exploration(LC+LCBDE),laparoscopic cholecystectomy combined with duodenoscopic lithotripsy(LC + ERCP / EST)the two minimally invasive surgery is equivalent to a safe and effective surgical treatment of cholecystolithiasis with choledocholithiasis should be based on individual patient conditions and hospital equipment and technical conditions to select the combination mode.Laparoscopic common bile duct exploration without T-tube drainage,retained the duodenal sphincter integrity,to avoid the complications associated with indwelling T-tube,highlighting the advantages of minimally invasive surgery,is a safe and feasible surgical method,it is worth applying and promoting in clinical practice.