Clinical Application Of Pre-positioned Zebra Guide Wire In T-tube Removal After Laparoscopic Common Bile Duct Exploration

Objective:To explore the clinical value of zebra guide wire in t-tube removal after laparoscopic common bile duct exploration.Methods:Clinical data of patients who received T-tube removal after laparoscopic common bile duct exploration in the third ward of the Hepatobiliary and Pancreatic Surgery Department of the Second Affiliated Hospital of Kunming Medical University from January 2017 to February 2020 were collected.According to the inclusion criteria and exclusion criteria,330 patients were enrolled in the study.On the basis of detailed communication between doctors and patients and their families,The patients were not randomly divided into two groups by the decision of patients and their families:the conventional group(180 cases)and the zebra guide wire group(150 cases).Operation period,status of T tube sinus tract,main laboratory test indicators on the first day after operation(white blood cells,serum total bilirubin,alanine transaminase,aspartate transaminase,albumin),reoperation rate,hospitalization time,and hospitalization cost were compared and analyzed in the two groups.Results:Operation period:(21.93±10.32)min in zebra guide wire group,shorter than(23.34±11.02)min in conventional group,but the difference was not statistically significant(P>0.05).T-tube sinus defect:4 cases(2.6%)in zebra guide wire group,less than 9 cases(5%)in conventional group,but the difference was not statistically significant(P>0.05).White blood cell(WBC)on the first day after operation:(6.82±1.96)10^9/L in zebra guide wire group,lower than(7.23±3.45)10^9/L in conventional group,but the difference was not statistically significant(P>0.05),Serum total bilirubin(TBIL)on the first day after operation:(1 7.52±5.59)umol/1 in zebra guide wire group,lower than(18.24±6.01)umol/l in conventional group,but the difference was not statistically significant(P>0.05).Alanine transaminase(ALT)on the first day after operation:(27.87±10.92)IU/L in zebra guide wire group,lower than(28.94±10.76)IU/L in conventional group,but the difference was not statistically significant(P>0.05).Aspartate transaminase(AST)on the first day after operation:(27.13±10.74)IU/L in zebra guide wire group,higher than(26.42±11.25)IU/L in conventional group,but the difference was not statistically significant(P>0.05).Serum albumin(ALB)on the first day after operation:(39.01±4.98)g/L in zebra guide wire group,lower than(39.38±5.21)g/L in conventional group,but the difference was not statistically significant(P>0.05).Reoperation rate:0(0%)in zebra guide wire group,lower than 7 cases(3.9%)in conventional group,the difference was statistically significant(P<0.05).Hospitalization time:(5.24±1.86)days in zebra guide wire group,longer than(4.97±2.45)days in conventional group,but the difference was not statistically significant(P>0.05).Hospitalization costs:(5.12±1.34)thousand yuan in zebra guide wire group,higher than(4.68±2.27)thousand yuan in conventional group,the difference was statistically significant(P<0.05).Conclusion:It was safe and feasible to use zebra guide wire to remove T-tube after LCBDE,which could improve the operation efficiency of choledochoscopy diagnosis and treatment after tube removal,facilitate re-intubation after bile leakage,and effectively avoid further development of bile leakage,and reduce the reoperation rate after tube removal,it was worth popularizing and applying in clinic.