# Effect of Microscope Combined with Wechat Smart Platform on Clinical Efficacy and Gastrointestinal Function of Patients with Cholecystolithiasis Combined with Common Bile Duct Stones

Authors: Xu Xu; Dongmei Guo; Yan Zhang; Dandan Yang; Guangbin Hou; Quanfu Li; Changqing Ge; Zengwang Qie; Yonggang Zhong
Journal: Scanning
 (2022)

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## Abstract

To explore the clinical efficacy of microscope combined with Wechat smart platform in patients with cholecystolithiasis and choledocholithiasis, this paper proposes the effect of microscope combined with Wechat smart platform intervention after laparoscopic lithotomy and choledocholithotomy on the clinical efficacy and gastrointestinal function of patients with cholecystolithiasis combined with choledocholithiasis. From February 2018 to March 2019, 78 patients with gastric cancer were selected by our clinic and included in the research team. Evaluate the efficacy of endoscopic biliary lithotomy (LBL) + bile duct lithotomy (TBL) + T-tube drainage therapy to provide reliable evidence for improved efficacy and efficacy in order to provide a strong reference for improving the effectiveness and safety of surgical treatment of choledocholithiasis. Safety of surgical treatment of diseases. Gallstone disease. The experiments did not show any significant differences between the two groups during surgery. Diabetes was lower in the control group, and hospital incidence was lower in the control group. There were no significant differences between the two groups for preoperative WHOQOL-100 scores. Two weeks and four weeks after surgery, the man-key-100 score was higher than that of the control group. Endoscopic cholecystectomy + choledocholithotomy + choledochoscopic lithotomy + T-tube fluid have been shown to be effective in promoting rapid intestinal function and improving patient quality of life and are appropriate for therapeutic use.


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## Body

## 1. Introduction

Nowadays, young adults rely more on the online world for interpersonal communication. Wechat platform is a highly influential interactive information dissemination platform, which not only has text function, but also can add pictures, voice, and video. Through the health publicity of Wechat platform, patients and their families can obtain effective nursing knowledge related to diseases more directly and quickly [1]. It not only saves human resources, but also enables patients to continue to obtain relevant knowledge after discharge, and can communicate with medical staff anytime and anywhere. It is an efficient way of work. The degree of nursing knowledge of minimally invasive operation for gallstones was investigated in the continuous care of patients. By investigating the patients’ awareness of gallbladder disease and their satisfaction with health education, the clinical efficacy of wechat platform health education in the continuous care of patients undergoing minimally invasive gallstone surgery was explored [2, 3]. The incidence rate is about 12% ~ 18%. The incidence rate of gallstone is rising because of the change of living standard. However, 8%~25% of patients have choledocholithiasis, which may lead to serious complications if effective treatment is not taken in time [4, 5]. However, the treatment of cholecystolithiasis combined with common bile duct stones is more difficult. Therefore, it is necessary to innovate the treatment scheme to improve the treatment effect of cholecystolithiasis combined with common bile duct stones, as shown in Figure 1.Figure 1
Cholecystolithiasis combined with choledocholithiasis.


## 2. Literature Review

To solve this research problem, Rasheed, N. et al. studied the use of traditional open surgery for choledocholithiasis, and the postoperative complication rate was 20%, indicating that there were many postoperative complications. Laparoscopic cholecystectomy can explore and observe the abdominal cavity through high brightness and multiangle, and the operation field is enlarged under the display of endoscope, which is conducive to overall grasp and local fine operation [6]. Sebastian, M. and others used laparoscopic cholecystectomy to treat common bile duct stones. It shows that laparoscopic cholecystectomy combined with choledochotomy and choledochofiberscope lithotomy T-tube drainage can reduce blood loss and shorten abdominal drainage time, intestinal function normalization time, and hospital stay [7]. Akool, M. A. and others studied that laparoscopic cholecystectomy was used to treat common bile duct stones, and the postoperative complications were only 6% [8]. VV Boiko and others found that after cholecystectomy, it is easy to have insufficient bile, resulting in abdominal distension and diarrhea after eating. How to preserve the gallbladder and its functional integrity while ensuring the surgical effect is a hotspot in clinical research [9]. Boiko, V. V. and others performed duodenoscopy, choledochoscopy, and laparoscopy combined with cholelithotomy for the patients in the observation group. Different endoscopes can give full play to their own advantages and improve the stone clearance rate, and the clinical effect is definite [10]. Osuch, C. and others believe that after cholecystectomy, although the recurrence of gallstones can be avoided, there is compensatory expansion of common bile duct, resulting in narrow opening of duodenal papilla, resulting in the change of bile flow characteristics of common bile duct, and increasing the recurrence rate of common bile duct stones [11]. Klarica, L. and others found that LC combined with bile duct exploration can significantly shorten the length of incision, improve the speed of postoperative recovery, and reduce the economic burden of patients because of its use of minimally invasive technology [12]. Hao, Jiang and others used LC combined with bile duct exploration to treat common bile duct stones combined with gallbladder stones, which helps to preserve the integrity of duodenal papilla, and can treat gallbladder stones and common bile duct stones at one time, which is more in line with normal physiological conditions [13].Based on the current research, this paper proposes the effect of laparoscopic lithotomy and choledocholithotomy with microscope combined with Wechat smart platform on the clinical efficacy and gastrointestinal function of patients with cholecystolithiasis combined with choledocholithiasis. Laparotomy was performed in the study group and in the control group. There were no significant differences in the operating time of the two groups.


## 3. Method

### 3.1. Data

The medical records of 78 gallstones patients treated in our hospital from February 2018 to March 2019 were divided into two groups, with 39 patients in each group. The control group included 21 males and 18 females. Age range is 26 to 73 years and average (48.31±2.11) years. The course of disease is 1 ~ 11 years, the average (5.57±0.24) years. 21 men and 18 women on the board. Ages are between 25 and 74 years and average (48.33 ± 2.12) years. The course of disease is 1-11 years, the average (5.55±0.25) years. There was no significant difference in clinical data such as gender and age between the two groups, indicating comparability. This study was approved by the Medical and Ethical Research Institute of our hospital. Inclusion criteria: surgical treatment was required for choledocholithiasis. Patients should be conscious and can actively cooperate with this study. In this study, laparoscopic cholecystectomy, choledochotomy, choledochoscopic lithotomy and T tube drainage were well tolerated, and there were no relevant contraindications. The number of calculi was less than 5 and the maximum diameter of calculi was less than 2 cm; patients and their families were fully informed of the study contents and signed relevant agreements. Exclusion criteria are as follows: patients with recurrent choledocholithiasis [14, 15]; patients with other gallbladder diseases; patients with a history of abdominal surgery; patients with malignant tumors; female patients with choledocholithiasis in special physiological periods such as pregnancy, puerperium, and lactation; persons with mental illness; and those who refuse to sign informed consent [16].


### 3.2. Method

(1)
Surgical Methods of Study GroupThe study group was treated with laparoscopic cholecystectomy + common bile duct incision, choledochoscopic lithotomy + T-tube drainage. The details were as follows: drinking and fasting for 8 hours before operation, continuous ECG monitoring and oxygen inhalation after entering the room, and routine general anesthesia; the four hole method was used to enter the abdominal cavity, effectively separate the gallbladder triangle, and remove the gallbladder; fine needle puncture to confirm the position of the common bile duct, make a longitudinal incision (length 0.5 ~ 1.0 cm) on the front wall of the common bile duct, select the appropriate specification of choledochoscope according to the diameter of the common bile duct, and place it through the operation hole; routinely explore the location, quantity, and size of common bile duct stones, and reasonably expand the incision according to the exploration results [17]; the stones in the common bile duct were taken out with the stone taking basket, and the choledochoscope was used to explore again to determine whether there were stones left in the common bile duct and intrahepatic bile duct and to confirm that the duodenal papilla was unblocked; after washing the common bile duct effectively with 0.9% sodium chloride solution, place a “t” tube for drainage, close the incision of the common bile duct, place the drainage tube in the small omental hole, and close each incision of the abdominal wall. One month after operation, pull out the drainage tube after the T-tube cholangiography is clear that there is no stone residue and the common bile duct is unobstructed [18, 19].
(2)
The details were as follows: the preoperative preparation was the same as that of the study group. After general anesthesia, take the middle of the upper abdomen (slightly to the right) to make a straight incision, routinely explore the gallbladder, dissect the gallbladder triangle, and remove the gallbladder (combination of forward and reverse). After the common bile duct was cut, the stones were taken out, and the “t” drainage tube was routinely placed; the postoperative treatment was the same as that in the study group


### 3.3. Observation Indicators

Intestinal function: The recovery time of intestinal sounds and the first exhaust time of anus were recorded in the two groups. Complications: The occurrences of postoperative abdominal infection, acute cholangitis, acute pancreatitis, and other complications in the two groups were recorded [20]. Quality of life: The world Health Organization (WHO) quality of life measurement scale was used. The scores of each item of the WHOQOL-100 scale were 0 ~ 4 (involving social relations, psychology, environment, physiology, independence, spiritual pillar and other evaluation contents). The total score was 0 ~ 100 [21, 22].


## 3.1. Data

The medical records of 78 gallstones patients treated in our hospital from February 2018 to March 2019 were divided into two groups, with 39 patients in each group. The control group included 21 males and 18 females. Age range is 26 to 73 years and average (48.31±2.11) years. The course of disease is 1 ~ 11 years, the average (5.57±0.24) years. 21 men and 18 women on the board. Ages are between 25 and 74 years and average (48.33 ± 2.12) years. The course of disease is 1-11 years, the average (5.55±0.25) years. There was no significant difference in clinical data such as gender and age between the two groups, indicating comparability. This study was approved by the Medical and Ethical Research Institute of our hospital. Inclusion criteria: surgical treatment was required for choledocholithiasis. Patients should be conscious and can actively cooperate with this study. In this study, laparoscopic cholecystectomy, choledochotomy, choledochoscopic lithotomy and T tube drainage were well tolerated, and there were no relevant contraindications. The number of calculi was less than 5 and the maximum diameter of calculi was less than 2 cm; patients and their families were fully informed of the study contents and signed relevant agreements. Exclusion criteria are as follows: patients with recurrent choledocholithiasis [14, 15]; patients with other gallbladder diseases; patients with a history of abdominal surgery; patients with malignant tumors; female patients with choledocholithiasis in special physiological periods such as pregnancy, puerperium, and lactation; persons with mental illness; and those who refuse to sign informed consent [16].


## 3.2. Method

(1)
Surgical Methods of Study GroupThe study group was treated with laparoscopic cholecystectomy + common bile duct incision, choledochoscopic lithotomy + T-tube drainage. The details were as follows: drinking and fasting for 8 hours before operation, continuous ECG monitoring and oxygen inhalation after entering the room, and routine general anesthesia; the four hole method was used to enter the abdominal cavity, effectively separate the gallbladder triangle, and remove the gallbladder; fine needle puncture to confirm the position of the common bile duct, make a longitudinal incision (length 0.5 ~ 1.0 cm) on the front wall of the common bile duct, select the appropriate specification of choledochoscope according to the diameter of the common bile duct, and place it through the operation hole; routinely explore the location, quantity, and size of common bile duct stones, and reasonably expand the incision according to the exploration results [17]; the stones in the common bile duct were taken out with the stone taking basket, and the choledochoscope was used to explore again to determine whether there were stones left in the common bile duct and intrahepatic bile duct and to confirm that the duodenal papilla was unblocked; after washing the common bile duct effectively with 0.9% sodium chloride solution, place a “t” tube for drainage, close the incision of the common bile duct, place the drainage tube in the small omental hole, and close each incision of the abdominal wall. One month after operation, pull out the drainage tube after the T-tube cholangiography is clear that there is no stone residue and the common bile duct is unobstructed [18, 19].
(2)
The details were as follows: the preoperative preparation was the same as that of the study group. After general anesthesia, take the middle of the upper abdomen (slightly to the right) to make a straight incision, routinely explore the gallbladder, dissect the gallbladder triangle, and remove the gallbladder (combination of forward and reverse). After the common bile duct was cut, the stones were taken out, and the “t” drainage tube was routinely placed; the postoperative treatment was the same as that in the study group


## 3.3. Observation Indicators

Intestinal function: The recovery time of intestinal sounds and the first exhaust time of anus were recorded in the two groups. Complications: The occurrences of postoperative abdominal infection, acute cholangitis, acute pancreatitis, and other complications in the two groups were recorded [20]. Quality of life: The world Health Organization (WHO) quality of life measurement scale was used. The scores of each item of the WHOQOL-100 scale were 0 ~ 4 (involving social relations, psychology, environment, physiology, independence, spiritual pillar and other evaluation contents). The total score was 0 ~ 100 [21, 22].


## 4. Results

### 4.1. Comparison of Surgical Indexes between the Two Groups

Diabetes mellitus is lower in the control group, and after hospitalization, it is lower in the control group, with a significant difference (P<0.05), as shown in Table 1.Table 1
Comparison of surgical indexes between the two groups.
GroupIntraoperative timeIntraoperative bleedingPostoperative hospital stayResearch group94.37±13.3850.54±10.176.73±0.18Control group94.26±13.32106.61±18.2210.55±0.37


### 4.2. Comparison of Intestinal Function between the Two Groups

In the study group, postoperative bowel noise and the first time postoperative rectal excretion time are shorter in the control group as shown in Table2 (P<0.05).Table 2
Comparison of postoperative intestinal function recovery between the two groups.
GroupPostoperative bowel sounds recovery timeFirst postoperative anal exhaust timeResearch group32.36±5.1215.34±3.18Control group60.54±9.8541.27±6.52


### 4.3. Comparison of Complications between the Two Groups

No patients had two or more problems occurring at the same time in this study. The incidence of problems in the control group was lower than in the control group, and the difference was significant (P<0.05) (see Table 3).Table 3
Comparison of postoperative complications between the two groups.
GroupSubcutaneous effusionSubcutaneous emphysemaIncision infectionAbdominal infectionAcute cholangitisAcute pancreatitisTotalResearch group02.570002.575.14Control group7.6802.572.572.57017.96


### 4.4. Comparison of Quality of Life between the Two Groups

There was no significant difference between the two groups in preoperative WHOQOL-100 scale score, at 2 and 4 weeks after operation (see Table4 and Figure 2).Table 4
Comparison of wh0qol-100 scores between the two groups.
GroupPreoperative2 weeks after operation4 weeks after operation8 weeks after operationResearch group64.36±6.1272.55±3.6979.83±3.9285.27±3.65Control group64.37±6.1164.32±6.0973.37±4.5685.26±3.67Figure 2
Comparison of wh0qol-100 scale scores between the two groups.


### 4.5. Discussion

The open surgery operation has been used in clinic to provide good surgical field for the operator and obtain ideal stone clearance rate. However, the patients with large trauma and high blood loss are not conducive to postoperative health recovery, and the incidence rate of postoperative complications is high, which may increase the hospitalization time and treatment cost of [23, 24]. Endoscopic retrograde cholangiopancreatography choledocholithotomy has been gradually applied to the treatment of choledocholithiasis. However, after this operation, the patient needs to choose another time for laparoscopic cholecystectomy, and the patient will suffer secondary trauma. Therefore, it is not conducive for them to actively accept this scheme and cooperate with the treatment room. Laparoscopic cholecystectomy + choledocholithotomy + choledochoscopy + T-tube drainage is one of the minimally invasive treatment schemes for choledocholithiasis popularized in the clinic at this stage. During the operation, choledochoscopy is used to explore the local bile duct lesions and take stones with the help of laparoscope, which can effectively reduce the surgical trauma and bleeding [25]. In addition, laparoscopic cholecystectomy + choledochotomy, choledochoscopic lithotomy + T-tube drainage can completely preserve the structure of duodenal papillary sphincter, reduce the risk of abnormal conditions such as biliary infection and intestinal reflux, and solve the operations such as lithotomy and cholecystectomy at one time, which can effectively avoid the injury of patients after secondary surgery, which is of great significance to promote the recovery of patients’ health as soon as possible and ensure their quality of life. Postoperative intestinal function recovery, postoperative complications, postoperative quality of life, and other indicators of the study group are treated with laparoscopic cholecystectomy + choledochotomy + choledochoscopy + T-tube drainage.Cholecystolithiasis combined with choledocholithiasis is a common surgical disease. With the continuous maturity of endoscopic technology such as choledochoscopy, laparoscopy, and duodenoscopy and the deepening of minimally invasive concept, in recent years, there are many reports on the combination of endoscopic cholangiopancreatography, duodenal papillotomy, bile duct stone removal, and laparoscopic cholecystectomy. However, some scholars believe that the above operation requires cholecystectomy, which may damage the bile duct and cause a variety of complications. Another study found that after cholecystectomy, it is easy to have insufficient bile, resulting in abdominal distension and diarrhea after eating. How to preserve the gallbladder and its functional integrity while ensuring the surgical effect is a hotspot in clinical research.


## 4.1. Comparison of Surgical Indexes between the Two Groups

Diabetes mellitus is lower in the control group, and after hospitalization, it is lower in the control group, with a significant difference (P<0.05), as shown in Table 1.Table 1
Comparison of surgical indexes between the two groups.
GroupIntraoperative timeIntraoperative bleedingPostoperative hospital stayResearch group94.37±13.3850.54±10.176.73±0.18Control group94.26±13.32106.61±18.2210.55±0.37


## 4.2. Comparison of Intestinal Function between the Two Groups

In the study group, postoperative bowel noise and the first time postoperative rectal excretion time are shorter in the control group as shown in Table2 (P<0.05).Table 2
Comparison of postoperative intestinal function recovery between the two groups.
GroupPostoperative bowel sounds recovery timeFirst postoperative anal exhaust timeResearch group32.36±5.1215.34±3.18Control group60.54±9.8541.27±6.52


## 4.3. Comparison of Complications between the Two Groups

No patients had two or more problems occurring at the same time in this study. The incidence of problems in the control group was lower than in the control group, and the difference was significant (P<0.05) (see Table 3).Table 3
Comparison of postoperative complications between the two groups.
GroupSubcutaneous effusionSubcutaneous emphysemaIncision infectionAbdominal infectionAcute cholangitisAcute pancreatitisTotalResearch group02.570002.575.14Control group7.6802.572.572.57017.96


## 4.4. Comparison of Quality of Life between the Two Groups

There was no significant difference between the two groups in preoperative WHOQOL-100 scale score, at 2 and 4 weeks after operation (see Table4 and Figure 2).Table 4
Comparison of wh0qol-100 scores between the two groups.
GroupPreoperative2 weeks after operation4 weeks after operation8 weeks after operationResearch group64.36±6.1272.55±3.6979.83±3.9285.27±3.65Control group64.37±6.1164.32±6.0973.37±4.5685.26±3.67Figure 2
Comparison of wh0qol-100 scale scores between the two groups.


## 4.5. Discussion

The open surgery operation has been used in clinic to provide good surgical field for the operator and obtain ideal stone clearance rate. However, the patients with large trauma and high blood loss are not conducive to postoperative health recovery, and the incidence rate of postoperative complications is high, which may increase the hospitalization time and treatment cost of [23, 24]. Endoscopic retrograde cholangiopancreatography choledocholithotomy has been gradually applied to the treatment of choledocholithiasis. However, after this operation, the patient needs to choose another time for laparoscopic cholecystectomy, and the patient will suffer secondary trauma. Therefore, it is not conducive for them to actively accept this scheme and cooperate with the treatment room. Laparoscopic cholecystectomy + choledocholithotomy + choledochoscopy + T-tube drainage is one of the minimally invasive treatment schemes for choledocholithiasis popularized in the clinic at this stage. During the operation, choledochoscopy is used to explore the local bile duct lesions and take stones with the help of laparoscope, which can effectively reduce the surgical trauma and bleeding [25]. In addition, laparoscopic cholecystectomy + choledochotomy, choledochoscopic lithotomy + T-tube drainage can completely preserve the structure of duodenal papillary sphincter, reduce the risk of abnormal conditions such as biliary infection and intestinal reflux, and solve the operations such as lithotomy and cholecystectomy at one time, which can effectively avoid the injury of patients after secondary surgery, which is of great significance to promote the recovery of patients’ health as soon as possible and ensure their quality of life. Postoperative intestinal function recovery, postoperative complications, postoperative quality of life, and other indicators of the study group are treated with laparoscopic cholecystectomy + choledochotomy + choledochoscopy + T-tube drainage.Cholecystolithiasis combined with choledocholithiasis is a common surgical disease. With the continuous maturity of endoscopic technology such as choledochoscopy, laparoscopy, and duodenoscopy and the deepening of minimally invasive concept, in recent years, there are many reports on the combination of endoscopic cholangiopancreatography, duodenal papillotomy, bile duct stone removal, and laparoscopic cholecystectomy. However, some scholars believe that the above operation requires cholecystectomy, which may damage the bile duct and cause a variety of complications. Another study found that after cholecystectomy, it is easy to have insufficient bile, resulting in abdominal distension and diarrhea after eating. How to preserve the gallbladder and its functional integrity while ensuring the surgical effect is a hotspot in clinical research.


## 5. Conclusion

In this paper, the combination of choledoscopy, choledochoscopy, choledochoscopy, and choledochoscopy for choledochoscopy shows that postoperative bowel movements in patients with gallstones affect the quality of life and the treatment rate of fluid in patients with gallstones. The 78 patients with biliary tract disease treated between February 2018 and March 2019 were divided into two groups, with 39 patients in each group. Bleeding was less in the control group during the study and less in the hospital after surgery than in the control group (P<0.05). Previously, there was no difference between the two groups of WHOQOL-100 scores. The WHOQOL-100 score in the study group was higher in the control group between 2 and 4 weeks after work (P<0.05). Endoscopic cholecystectomy + choledoscopy + T bronchial fluid plays an important role in the treatment of gallstones, which improves the function of the digestive tract and improves the patient’s quality of life.



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