Clinical Analysis Of Laparoscopic Choledocholithotomy And Primary Suture Of Bile Duct And T-tube Drainage In The Treatment Of Choledocholithiasis

Objective: To compare and statistically analyze the therapeutic effects of laparoscopic choledocholithotomy with primary suture of bile duct and t-tube drainage on choledocholithiasis.Methods: Clinical data of 123 cases of cholecystolithiasis complicated with choledocholithiasis admitted to department of hepatobiliary surgery of jiangxi people's hospital from December 2016 to December 2018 were retrospectively analyzed.63 patients with laparoscopic cholecystectomy and choledochotomy line of first phase of the common bile duct suture group(PS),60 cases of patients with laparoscopic gallbladder excision + cut take bravery manager stone group placed T tube group(TD),two groups of data are analyzed using the results,including the operation time,intraoperative blood loss,extubation time,gastrointestinal function recovery time,hospital stay,and complications(bile leakage,fever,abdominal cavity infection,biliary tract bleeding,postoperative biliary peritonitis,residual stone rate and the rate of recurrence of stones).Results: All the 123 surgeries were completed successfully without death,PS group vs.TD group: in the operation time(min)(155.30±25.60vs162.37±35.35,P<0.05),intraoperative blood loss(ml)(42.14±35.98vs78.67±51.01,P<0.05),postoperative extubation time(d)[6(5-7)vs7(6-8),P < 0.05),postoperative recovery time of gastrointestinal function(d)[2(1-2)vs3(2-3),P < 0.05),postoperative length of hospital stay(d)[7(6-8)vs9(7.25-10),P < 0.05],PS group was better than TD group,with statistical significance.In terms of postoperative complications,postoperative bile leakage 2 cases of mild PS group,TD group of 3 cases of mild bile leakage,3 cases of postoperative fever,1 case of thrombocytopenia,1 case of biliary tract bleeding,1 case of residual,2 cases of stones recurrence of bile leakage after surgery,recurrence of fever,residual stones,stones and other complications in there was no significant difference(P>0.05),but always in the biliary complications and complications were statistically significant(P<0.05).Conclusion: Because of a series of disadvantages and postoperativecompl-ications,the minimally invasive advantages of laparoscopic choledocholithotomy in the treatment of choledocholithiasis are largely weakened.Compared with t-tube drainage,primary suture of bile duct has the advantages of shorter operation time,less bleeding,shorter abdominal drainage time,faster gastrointestinalrecovery,shorter postoperative hospitalization time,lower postoperative complications and so on,and can demonstrate the advantages of laparoscopic minimallyinvasive technique.Before the operation,the indications and contraindicationsof laparoscopic primary suture for bile duct exploration should be strictly grasped,and the techniques of laparoscopy and choledochoscopy should be skillfullymastered.The lithotomy instruments,laparoscopic suture techniques and knotting techniques should be skillfully applied.This method is safe and feasible for the treatment of choledocholithiasis,and is worthy of clinical application.