| Over years,hepatobiliary surgeons are endeavor to quest the most effective cure of recurrent common bile duct stones(CBDS).Before,traditional open common bile duct exploration(OCBDE)is regard as the unique therapeutic option.However,with the emerging of endoscopic and laparoscopic technologies,the management of recurrent CBDS become varied.Today,hepatobiliary surgeons have more options for the treatment of recurrent CBDS,including Endoscopic sphincterotomy(EST),OCBDE and laparoscopic common bile duct exploration(LCBDE).But,EST has many contraindications in clinical practice,such as number of stones,presence of tortuous ducts,or presence of periampullary duodenal diverticula,and varies depending on institutional and individual techniques and experiences.Especially,EST disturbed the anatomy of the sphincter of Oddi which has been postulated to cause stasis of bile and recurrent stone formation.With the emphasis on the sphincter of Oddi,more and more scholars performed surgery approaches.So,it is necessary to compare the therapeutic effects of combined choledochoscope-laparoscopic and traditional open surgery for recurrent common bile duct stones.Objective: to compare of the therapeutic effects of combined choledeochoscopelaparoscopic operation and traditional open surgery for recurrent common bile duct stonesMaterials and Methods: we retrospectively studied 65 patients with recurrent common bile duct stones who under reoperation in the Department of hepatobiliary surgery of the North SIchuan medical college between June 2014 and June 2017.They are divided into two groups according to the procedure of operation.LCBDE combined with intraoperative choledeochoscope plus T-tube drainage was performed 30 patients,and OCBDE combined with intraoperative choledeochoscope plus T-tube drainage was performed 35 patients.The items of operation were compared.Results:(1)preoperative data comparability analysis: statistical analysis of two groups of patients in gender,age,imaging examination,common bile duct diameter,stone number,size,history of upper abdominal surgery and internal medicine merger was not statistically significant(P>0.05).(2)the comparative analysis of the data in the operation: there was no statistical difference between the two groups of operation time and the amount of bleeding during the operation(P>0.05)(3)postoperative recovery: two groups of patients within 3 days after the highest temperature,gastrointestinal function recovery time,hospitalization time had significant difference(P<0.05),.LEBDE group was the highest temperature within 3 days,gastrointestinal function recovery time,hospitalization time were lower than the OCBDE group,especially in hospital time,LCBDE group obviously compared to OCBDE group.Two groups of patients in the first time after the operation and the number of postoperative analgesics,through comparison found that there were significant differences(P<0.05),group LCBDE patients to get out of bed activity earlier than the OCBDE group,and the number of postoperative analgesics was significantly lower than the OCBDE patients.(4)postoperative short-term complications: statistical analysis of postoperative short-term complications: biliary fistula,biliary stricture,postoperative bleeding,postoperative pancreatitis,and stone residual rates were not statistically significant(P>0.05).Conclusion: Laparoscopic common bile duct exploration and intraoperative choledochoscopy,T tube drainage for the treatment of recurrent bile duct stones,compared with traditional open surgery,with surgical trauma,postoperative recovery time is short,short hospitalization time,postoperative complications and the rate of residual stones on the open abdominal surgery and had no significant difference.So it is a safe and effective treatment of recurrent common bile duct stones,but the clinical application should pay attention to the flexibility in operation and strictly grasp the operation. |
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