Postoperative Laparoscopic Hepatectomy And Biliary Exploration For Intrahepatic Cholangiolithiasis: Comparison Of The Clinical Efficacy Of Primary Suture And T Tube Drainage

Objective:To compare and analyze the effect of primary suture and T tube drainage after laparoscopic hepatectomy + biliary exploration for intrahepatic bile duct calculi.The indications of primary suture in laparoscopic hepatectomy and biliary tract exploration were discussed to provide a theoretical basis for its clinical use.Methods:We conducted a retrospective analysis of patients who received laparoscopic partial hepatectomy + biliary tract exploration in PLA General Hospital from October 2008 to October 2018,collected relevant clinical data and follow-up data of the patients,and finally 89 patients were included in our study after strict inclusion and exclusion criteria.Among the 89 patients enrolled in our study,44/89 patients who received laparoscopic partial hepatectomy + biliary tract exploration + primary suture were divided into PS group and 45/89 patients who received laparoscopic partial hepatectomy + biliary tract exploration +T tube drainage were divided into TTD group.According to the general information,operation time,hospital stay,postoperative exhaust time,postoperative recovery time,the occurrence of complications of the two groups of patients were compared and analyzed.The patients were followed up every 3 and 6 months postoperatively for 18 months.Results:Patients in PS group and TTD group were successfully cured and discharged.There was no significant difference in general data(P>0.05).Compared with TTD group,the mean postoperative hospital stay,postoperative exhaust time and postoperative recovery time in PS group were lower than those in TTD group,the differences were statistically significant(P<0.05).The operative time,intraoperative blood loss and postoperative removal time of abdominal drainage tube in PS group were lower than those in TTD group,but the differences were not statistically significant(P>0.05).The complication rate of PS group was lower,and the difference was statistically significant(P<0.05).In the PS group,there were 4 total complications(9.1%),of which 2 patients reported low-level biliary leakage and 2 patients developed acute pancreatitis.The total complications in TTD group were 12(26.6%),including leakage around the drainage site of T tube in 4 patients,intrahepatic bile accumulation in 2 patients,T tube distortion in 2 patients,and acute pancreatitis in 4 patients.No incision infection,residual bile duct stones and bile duct stricture were found in both groups.During 18 months of outpatient follow-up,no recurrence of intrahepatic bile duct stones or bile duct stenosis was recorded in all patients after discharge,and no missed diagnosis or death was found in the follow-up.Conclusion:This study showed that laparoscopic hepatectomy combined with choledochoscopy was effective in the treatment of intrahepatic bile duct calculi.When the common bile duct diameter > 1 cm,no serious bile duct inflammation,confirmed by intraoperative ultrasound and choledochoscope bile duct residue,without biliary tract cancer and bile duct stricture and biliary diseases and normal on unobstructed,oddi sphincter function below bravery manager of laparoscopic hepatectomy + postoperative choledochoscope to probe the application issue suture is feasible,beneficial.