A Comparative Study Of Primary Sutured Common Bile Duct And Indwelling T Tube In The Application Of PTCD Sequential LCBDE

Objective(s): Through retrospective analysis of the clinical data of patients with simple common bile duct stones and moderate acute cholangitis(with gallstones),and comparing the curative effects of simple primary suture and indwelling T tube treatment methods in laparoscopic common bile duct exploration after PTCD drainage,it is hoped that clinicians can provide some data reference in the choice of two surgical methods.Methods : The clinical data of 62 patients with simple cholangithiasis with moderate acute cholangitis admitted to the Department of Hepatobiliary Surgery of the Second Affiliated Hospital of KUNMING Medical University from September 2018 to September 2022 were collected,and all patients were divided into two groups after admission in accordance with the "Tokyo Guidelines(2018)Diagnosis and Treatment Strategies for Acute Biliary Tract Infection" and "Guidelines for the Diagnosis and Treatment of Acute Biliary System Infection(2021 Edition)",and divided into two groups according to the different ways of treating the biliary tract during surgery.Primary suture group(31 cases):P TCD+ laparoscopic cholecystectomy + common bile duct exploration primary suture group(PTCD+LC+LCBDE+PDC)The T-tube group(31 cases):P TCD + laparoscopic cholecystectomy + common bile duct exploration indwelling T tube group(PTCD+LC+LCBDE+TTD)Grouping basis: Since there are no guidelines to clearly report the indications for the first stage suture of the common bile duct,this article only summarizes the experience of the senior title hepatobiliary surgeon in our hospital,and takes(1)the diameter of the common bile duct is ≥0.8cm,(2)the common bile duct has no obvious edema and the bile duct wall is thin,(3)the biliary tract has no mass lesions and the papillary muscle function is well performed with the first stage suture of the common bile duct.The general data,specialized data,operation time,intraoperative blood loss,postoperative ventilation time,abdominal drainage time,hospital stay,hospitalization cost,incidence of postoperative complications,stone recurrence and other indicators of the two groups were statistically analyzed,and the effect differences between the two surgical methods were compared.SPSS26.0 software was used to process the data,and the difference was statistically significant with P<0.05.Results:1.Preoperative dataThe statistical results showed that there was no significant difference in age,sex,underlying diseases(hypertension,diabetes,coronary heart disease),and specialized data(common bile duct diameter,number of stones,ALT,AST,total bilirubin,alkaline phosphatase,white blood cells)between the two groups(P>0.05).2.Intraoperative conditionsThe average operation time of patients in the primary suture group was 162.9±7.8min,and the average operation time of patients in the T tube group was 197.9±7.2min,and the difference in the operation time between the two groups was statistically significant(P=0.02),the operation time of patients in the primary suture group was significantly less than that in the T tube group,the average intraoperative blood loss of patients in the primary suture group was 57.1±5.2ml,and the average intraoperative blood loss of patients in the T tube group was 70.6±5.7ml.There was no significant difference in intraoperative blood loss between the two groups(P=0.086,P>0.05).3.Postoperative conditionsThe average hospital stay of patients in the primary suture group was 13.5±1.0 days,and the average length of stay of patients in the T tube group was 15.9±0.5 days,and the difference in the length of stay of patients in the two groups was statistically significant(P=0.035),and the hospitalization time of patients in the primary suture group was significantly less than that in the T tube group,the average hospital cost of patients in the primary suture group was 24245.1±862.7 yuan,and the average hospitalization cost of patients in the T tube group was 27994.9±898.6 yuan.The difference in hospitalization costs between the two groups was statistically significant(P=0.004),and the hospitalization cost of patients in the primary suture group was significantly lower than that in the T tube group,the average abdominal drainage time of patients in the primary suture group was 5.29±0.18 days,and the average abdominal drainage time of patients in the T tube group was 3.65±0.15 days.The difference in abdominal drainage time between the two groups was statistically significant(P<0.001),and the peritoneal drainage time in the primary suture group was significantly longer than that in the T tube group,and there was no significant comparison between the two groups in terms of postoperative ventilation time and bed rest time(P>0.05),and there was no significant difference in the incidence of postoperative pancreatitis,bile leakage,common bile duct stenosis,stone recurrence and incision infection between the two groups(P>0.05).Conclusion(s):1.After preoperative indwelling PTCD tube,elective LC+LCBDE+PDC and LC+LCBDE+TTD are effective surgical methods for the treatment of simple common bile duct stones with moderate cholangitis(with gallstones),and both groups of patients have achieved good treatment results after surgery.2.Preoperative indwelling PTCD tube,elective LC+LCBDE patients,whether using a phase suture or indwelling T tube,there is a risk of pancreatitis,bile leakage and stone recurrence,but the incidence of pancreatitis,biliary leakage and stone recurrence in the two groups is not statistically significant.3.Compared with the T tube group,the advantages of the primary suture group were significantly greater than those in the T tube group,mainly because the operation time and hospital stay of patients in the primary suture group were shorter,and the hospitalization cost was relatively low,but in the comparison of abdominal drainage time,the abdominal drainage time of the T tube group was significantly shorter than that of the primary suture group.