Analysis Of Clinical Effectiveness Of Iaparoscopic Cholecystoscopy Combined With Choledochoscope For Choledochal Duct Stones

Objectives This paper is designed to study the therapeutic effect of laparoscopic transcystic common bile duct exploration in the application.Methods The researchers retrospectively analyzed the 165 patients who received treatment in Kailuan General Hospital affiliated to North China University of Science and Technology from February 2014 to November 2016 for gallstone combined with choledocholithiasis.They assigned them into three groups: the study group(56 cases,the laparoscopic transcystic common bile duct exploration,LTCBDE),the A group(67 cases,laparoscopic trans-duct common bile duct exploration,LTDBDE + T tube postoperative drainage group),and the B group(42 cases,Laparoscopic exploration And Primary Suture Of Bile Duct,LBEPS).The observation target include the achievement ratio of operation,no conversion to laparotomy,duration of operation,bleeding volume during operation,working time of abdominal cavity drainage tube,the first aerofluxus time after operation,total length of hospital stay,medical and hospital expenses,postoperative morbidity.The follow-up lasted for 6 to 20 months to observe the mid-term and long-term clinical effect of these three groups through call and out-patient review.Results There is no outstanding differences in patients' general and preoperative situation,age,gender,the number of gallbladder stone and the diameter of common bile duct among there groups(P < 0.05).So the materials have study and comparative value.The results of operation: in the study group,two patients showed relatively serious inflammation adhesion in gallbladder and common bile duct and it's hard to separate the duct of gallbladder,so they were converted to laparotomy(3.57%(2/56),fifty witnessed successful operation by LTCBDE(89.29%(50/56),and four were treated by LTDBDE + T tube postoperative drainage group in that their ducts of gallbladder were to short and narrow and the choledochoscope couldn't get through.The achievement ratio of operation for group A and group B were respectively 95.52%(64/67).and 95.24%(40/42).There were 3 in group A(4.48%,3/67)and 2 in group B(4.76%,2/42)who were also converted to laparotomy for the same reason.Statistical analysis showed that there was no obvious difference among there groups in the the achievement ratio of operation and conversion to laparotomy(P > 0.05).Postoperative recovery: the observe targets in the study group,including duration of operation,bleeding volume during operation,working time of abdominal cavity drainage tube,the first aerofluxus time after operation,total length of hospital stay,and medical and hospital expenses,were P < 0.05.Postoperative complications: compared with group A and B,the study group was P > 0.05.Judging fromthe follow-up,no narrow ducts of gallbladder were found,which proved that there was no evident difference in the mid-term and long-term clinical effect among these three groupsConclusions Although there is no significant difference in the curative effect between LTCBDE and LTDBDE + T tube postoperative drainage or LBEPS,LTCBDE showed the advantages of minimally invasive surgery with less trauma,less bleeding,slighter stress reaction,shorter recovery time and less postoperative complications.More importantly,with the right judgement for the type of patients,this therapy method is worth of being promoted and applied in clinical application.