The Expansion Of Indications Of Primary Suture In Laparoscopic Common Bile Duct Exploration

Objective:To explore the clinical effect of primary suture following lapar oscopic common bile duct exploration,then expand the indications of primary suture following laparoscopic common bile duct explorati on.Method:A retrospective cohort study was conducted to collect and analyze the clinical data of 425 patients with extrahepatic bile duct stones with or without gallstone admitted from January 2015 to December 2017 in the The First Hospital of Jilin University.All 425 patients successfully performed laparoscopic cholecystectomy,among which 239 patients underwent T tube drainage,which was set as T tube drainage group(TD group).186 patients underwent primary suture,which was set as primary suture group(PS group).In the PS group,some patients with obstructive jaundice,acute biliary pancreatitis,multiple biliary surgery history,multiple upper abdominal surgery history,acute obstructive suppurative cholangitis,set as primary suture expansion group;The patients without such complications were set as control group.Observations:(1)Comparison of surgical conditions;(2)comparison of postoperative recovery;(3)comparison of postoperative complications;(4)follow-up.Follow-up using outpatient and telephone access to patients with postoperative complications.The follow-up period ended in February,2018.Normal distribution of measurement data to?±,comparison between group by t test.The measurement data of skewness distribution is expressed in M(quartile range),and non-parametric test is used for comparison between groups.Count data comparing thec~2 test or Fisher’s exact probability method.Results:Laparoscopic common bile duct exploration was successfully performed in all 425 patients.There were no deaths,including 238 males and 187 females.The mean age was 63 years,the youngest was 15 years and the oldest was 95 years.The difference was statistically significant between PS group and TD group during intraoperative blood loss,operation time,postoperative hospital stay,postoperative time of catheter removal,hospitalization expense and postoperative fasting water time(Z=-15.532、Z=-2.571、t=-7.379、t=-5.397、t=-4.894、t=-3.558、c~2=11.193、c~2=7.75、c~2=2.562、c~2=0.000,P<0.05).Moreover,the postoperative complications of PS group and the incidence of bile leakage were lower than that of TD group.Therefore,the PS group had obvious advantages compared with TD group.Expansion group(preoperative combined obstructive jaundice,history of previous abdominal surgery,history of biliary tract surgery,acute gallstone pancreatitis,acute obstruction suppurative cholangitis patients)and control group in the incidence of postoperative complications and bile leakage and statistical values respectively(9.9%、10.6%、c~2=0.024,7.9%、8.2%、c~2=0.006;9.4%,10.4%、c~2=0.03,6.2%、8.4%、c~2=0.172,12.0%、9.9%、c~2=0.100,8.0%、81%、c~2=0.000,9.1%、10.4%、c~2=0.034,4.5%、8.5%、c~2=0.417;10.5%、10.2%、c~2=0.002,10.5%、7.8%、c~2=0.173;P>0.05),the difference was not statistically significant.The complication rate was lower or slightly higher than the control group after the primary suture of the expansion group,indicating that the primary suture was also safe and feasible for these patients.(4)Follow-up:336 patients were followed up.There were160 cases in PS group,176 cases in TD group.The follow-up time ranged from 2 to 36 months and the median follow-up time was 15 months.Conclusion:Primary suture after laparoscopic common bile duct exploration is very good minimally invasive treatment of common bile duct calculi,changed the past long-term indwelling T tube defects,maintain theintegrity of Oddi sphincter,especially for some combination ofobstructive jaundice,acute gallstone pancreatitis,history of abdominal surgery,history of biliary tract surgery,and patients with acuteobstruction suppurative cholangitis,has obtained the good curative effect,worth clinical promotion.