Retrospective Analysis Of Laparoscopic Common Bile Duct Exploration In Patients With History Of Upper Abdominal Surgery

Objective To retrospectively analyze the early prognosis of laparoscopic common bile duct exploration and open common bile duct exploration in the treatment of patients with common bile duct stones who had a history of upper abdominal surgery,and to explore the safety and feasibility of laparoscopic common duct exploration,so as to better guide the choice of treatment options for patients.Methods Retrospective analysis of 80 cases of patients with common bile duct stones who had a history of upper abdominal surgery from November 2011 to May 2018 was performed.According to the surgical procedure,there were 30 cases in the laparoscopic group and 50 cases in the open group.The general clinical characteristics,perioperative laboratory test results,intraoperative conditions,postoperative recovery and early complications of the two groups were compared.Results A total of 5 cases in the laparoscopic group were converted to open surgery,the conversion rate was 16.7%(5/30).The amount of bleeding in the laparoscopic group was significantly lower than that in the open group(60.40±33.72 min vs.126.60±137.54 min P<0.05).The postoperative feeding time was significantly earlier in the laparoscopic group than in the open group(2±1.225 days vs.4.58±3.828 days P<0.05).Postoperative analgesia rate was 12%(3/25)in laparoscopic group and 38%(19/50)in open group,which was significantly lower in laparoscopic group than in open group(P<0.05).Postoperative hospital stay in laparoscopic group was significantly shorter than that in open group(7.12±1.878 days VS.13.58±8.942 days P<0.05).There was no significant difference between laparoscopic group and open group in operation time(167.16±67.85 min VS.150.60±57.34 min P<0.05).There was no significant difference in glutamyl transpeptidase between laparoscopic group and open group on the 3rd day after operation(204.65(+195.40U/L VS.199.38(+163.78U/L P>0.05).The recovery time of total bilirubin in laparoscopic group compared with that in open group was(4.32±2.66 days VS.5.63±2.95days),There was no significant difference between the two groups(P>0.05).the short-term overall complication rate was 8%(2/25)in laparoscopic group and 16%(8/50)in open group.There was no significant difference between the two groups(P>0.05).Conclusion 1.Laparoscopic treatment of Common bile duct stones patients with upper abdominal operation history is safe and feasible,and has the advantages of minimally invasive,but the indications of operation should be strictly controlled.2.Laparoscopic treatment can reduce intraoperative bleeding,advance postoperative feeding time,relieve postoperative pain,and shorten postoperative hospital stay time without increasing the risk of postoperative complications.