To Explore The Effectiveness Of Antegrade Intubation Of The Common Bile Duct In The Treatment Of Choledocholithiasis Combined With Gallstones

Objective:To investigate the effectiveness of antegrade intubation of the common bile duct in the treatment of choledocholithiasis combined with gallbladder stones.Methods:A retrospective analysis of the clinical data of 104 patients with choledocholithiasis combined with gallbladder stones underwent surgical treatment.Among them,they were divided into observation group,53 cases with endoscopic retrograde cholangiopancreatography+papillary sphincterotomy(referred to as retrograde intubation group),and experimental group with abdominal cavity 51 cases of anterograde guided choledochectomy and stone removal+primary suture of nasobile duct drainage(referred to as the anterograde intubation and stone removal group)were performed in 51 cases.The preoperative capital data of the two groups were compared,intraoperative blood loss,hospital stay,total operation time,Stone removal rate,postoperative anal exhaust time,bile drainage,total hospitalization costs,and complications.Results:All 51 patients in the anterograde intubation and stone removal group completed the operation.Postoperative complications:2 cases developed biliary leakage and were cured and discharged after conservative treatment;6 cases had fever after surgery,and blood routines suggested elevated white blood cells.After conservative and anti-infective treatments Improved and discharged;1 case developed pulmonary infection after operation and was treated with anti-infective treatment.50 cases in the retrograde intubation and stone removal group successfully completed the operation,of which 2 cases had residual stones in the follow-up follow-up,and were treated again.3 patients could not tolerate switching to the antegrade intubation and stone removal group.Postoperative complications:6 cases developed mild pancreatitis,3 cases had postoperative fever,2 cases developed pulmonary infection,2 cases of electrolyte imbalance were treated with conservative symptomatic treatment and were discharged from the hospital.1 case of nipple bleeding after nipple incision was performed.Didenoscope hemostasis treatment.There was no significant difference between the two groups in the largest diameter of the common bile duct,the diameter of the common bile duct,gender ratio,age,preoperative ALT,AST,preoperative total bilirubin,total postoperative complications,and three days postoperative nasobilirubin drainage volume.Significance(P>0.05),there are statistically significant differences in intraoperative blood loss,total hospitalization costs,hospitalization time,operation time,and postoperative anal exhaust time(P<0.05).Conclusion:1.The general condition is good,and those without a history of abdominal surgery can give priority to antegrade intubation and stone removal.It can reduce the occurrence of postoperative pancreatitis,the operation can solve the gallbladder stones and the common bile duct stones at the same time,and the hospitalization cost is lower.2.Retrograde intubation has obvious advantages for patients with advanced age,cardiopulmonary insufficiency,and acute suppurative cholangitis.It is an alternative to difficult laparoscopy.3.Both surgeries have advantages and disadvantages.Comprehensively consider all aspects of the patient’s factors,and customize a personalized surgical plan to maximize the benefit of the patient.