| Objective To compare the clinical effects of traditional laparotomy and double endoscopy in the treatment of cholecystolithiasis with choledocholithiasis in Tibet,and to analyze the effectiveness and safety of different surgical methods.Methods The general clinical data of 153 patients with cholecystolithiasis and choledocholithiasis who met the inclusion criteria in the Department of Hepatobiliary surgery of the people’s Hospital of Tibet Autonomous region from January 2017 to January 2020 were analyzed retrospectively.according to different surgical methods,they were divided into traditional laparotomy group(n=84)and double endoscope group(n=69).Conventional cholecystectomy + choledochotomy exploration + T-tube drainage(OC+OCBDE+TD)was used in the traditional laparotomy group,and laparoscopic cholecystectomy +choledocholithotomy exploration + T-tube drainage(LC+LCBDE+TD)was used in the double endoscopy group.The general clinical data of the patients before operation were collected and analyzed,and the intraoperative blood loss,operation time,postoperative removal of abdominal drainage tube,postoperative feeding time,postoperative hospitalization time and total hospitalization cost were compared between the two groups.the stone clearance rate and residual stone rate werecompared between the two groups.in addition,the occurrence of early postoperative complications(including postoperative bile leakage,incision infection,bleeding,abdominal infection,pulmonary infection,etc.)were grasped between the two groups.The postoperative complication grading system of Clavien-Dindo was used to stratify the severity of the disease.Results(1)there was no significant difference in preoperative general data(P>0.05)(including sex,age,BMI,number of preoperative complications,diameter of common bile duct,maximum diameter of stones,number of stones)and preoperative blood test indexes(ALT,AST,TP,ALB,TB,DB,IB,WBC,N)between the two groups.(2)Operation condition: the operation time in the laparotomy group was less than that in the double endoscope group(141.31 ±43.98 min VS 165.57 ±67.43min),and the difference was statistically significant(P< 0.05);The intraoperative blood loss in the combined endoscopy group was less than that in the laparotomy group(147.54±109.91 ml VS179.64 ±146.60ml),but the difference was not statistically significant(P>0.05).(3)The time of removal of abdominal drainage tube,postoperative feeding time,postoperative hospitalization time and hospitalization cost in the double endoscope group were better than those in the laparotomy group,and there was significant difference between the two groups(P<0.05).(4)The stone clearance rate and residual stone rate in the laparotomy group were97.6% and 2.4% respectively,while those in the double mirror group were 97.1% and 2.9%,respectively,and there was no significant difference between the two groups(P>0.05).(5)Both kinds of patients met the discharge standard and were discharged in accordance with the doctor’s advice.There was no significant difference in the levels of ALT,AST,TP,ALB,TB,DB,IB,WBC and N between the two groups before discharge.(P>0.05).(6)The total incidence of postoperative complications in the double endoscope group was 14.5%,which was significantly lower than that in the laparotomy group(29.8%),and the difference was statistically significant(P<0.05).The severity of complications was graded according to the postoperative complication grading system of ClavienDindo.The number of mild complications(Clavien I)in the combined double endoscopy group was more than that in the open group(84.1% VS70.2%).The incidence of more serious complications in the combined double endoscopy group was less than that in the open group(Clavien Ⅱ13.0% VS 22.6%)(Clavien III 2.9% VS 7.2%).However,there was no significant difference between the two groups(P>0.05),and no very serious complications(Clavien grade Ⅳ ～ Ⅴ)were observed in both groups.Conclusion 1.Traditional laparotomy group(OC+OCBDE+TD)and double endoscope combined with hand group(LC+LCBDE + TD)achieved good stone removal effect in the treatment of cholecystolithiasiswith choledocholithiasis.2.The time of removal of abdominal drainage tube,postoperative feeding time,postoperative hospital stay,hospitalization cost and the incidence of complications in double endoscopy group were significantly better than those in traditional laparotomy,and most of the complications were mild(Clavien gradeⅠ).Double-mirror combined operation has the advantages of less trauma,faster recovery,lower incidence of early postoperative complications and less hospitalization cost.it reflects the advantages of minimally invasive surgery and rapid recovery,and accords with the concept of modern minimally invasive,accurate and rapid rehabilitation surgery.3.The operation time of the combined double endoscope group was higher than that of the traditional laparotomy group,but through the learning curve,we can see that after continuous practice,the operation time of the double mirror combination group was decreasing,which was basically the same as that of the traditional laparotomy group in 2019. |
