Laparoscopic Progressive Catheter Dilatation Vs Laparoscopic Endoscopic Sphincterotomy In Gallstone With VATER Ampulla Obstruction Under A Triad Of Laparoscope,choledochoscope And Duodenoscopy

Objectiv:To compare and analyze the postoperative laboratory indexes and perioperative complications of transabdominal antegrade catheter papillary dilation and endoscopic papillotomy in the treatment of gallstone with Vater's ampulla obstruction,and to explore the clinical value of transabdominal antegrade catheter papillary dilation in the treatment of gallstone with Vater's ampulla obstruction.Methods:From January 2016 to December 2018,50 patients with choledocholithiasis in Chengdu Second People's hospital were treated with cholecystectomy + stage by stage catheter papillary dilation + endoscopic nasobiliary drainage(LPCD group)from January 2016 to December 2018,50 patients with choledocholithiasis in combination with choledocholithiasis were treated with cholecystectomy + endoscopic sphincterotomy + nasobiliary drainage(LEST group).The clinical data of the two groups were compared.The patients in the two groups were treated by the same group of doctors and performed different operation methods.The general data of the two groups before operation were compared: sex,age,ALT,AST,total bilirubin,direct bilirubin,ampulla diameter of common bile duct,diameter of common bile duct stone,etc Conclusion: alanine transferase,aspartate transferase,total bilirubin,direct bilirubin,length of stay,postoperative abdominal drainage,postoperative complications were analyzed statistically.Results:There was no statistical difference in preoperative general data such as gender and age between the two groups(P > 0.05),which was comparable.Surgerywas successful in both groups,with no conversion to laparotomy and no operative death.There was no significant difference in ALT,AST and total bilirubin between the two groups(P > 0.05).The amount of intraoperative bleeding in the LPCD group was less than that in the LEST group,and the difference between the two groups was statistically significant(P=0.000).The operation time in LPCD group was less than that in LEST group,and the difference between the two groups was statistically significant(P=0.000).The total amount of peritoneal drainage fluid in the LPCD group was less than that in the LEST group,and the difference between the two groups was statistically significant(P=0.000).The length of hospital stay in the LPCD group was less than that in the LEST group,and the difference between the two groups was statistically significant(P=0.000).The difference of direct bilirubin between LPCD group and LEST group was statistically significant(P=0.000).No complications such as bile leakage,pancreatitis,biliary hemorrhage and electrolyte disturbance occurred in the LPCD group after operation,while 3 cases of pancreatitis and 10 cases of electrolyte disturbance occurred in the LEST group after operation,and no bile leakage and biliary hemorrhage occurred.Conclusions:It is safe and effective to treat gallstone with Vater's ampulla obstruction by the way of abdominal antegrade catheter papillary dilation under the same period of three mirrors.This operation can effectively reduce the amount of bleeding and operation time,so as to significantly reduce the abdominal drainage after operation It is a safe,effective and feasible method of operation and has high clinical application value.