Clinical Analysis Of Three Different Treatments For Cholecystolithiasis With Choledocholithiasis

Objective:To evaluate the efficacy and the clinical application value of three different treatments for cholecystolithiasis with choledocholithiasis.Methods:From Jan.1993 to Jan.2009,the clinical data of 54 cases of cholecystolithiasis with choledocholithiasis treated at Fujian Provincial Hospital were analyzed retrospectively,among which 20 cases underwent OCHTD, 20 cases underwent EST+LC and 14 cases underwent LC+LCBDE.The postoperative recovery,the surgical effects and the hospitalization of the three groups were also compared.Results:1.General and clinical data: There was no statistical difference in the gender, age, comorbidity, WBC, TBIL and ALT among three groups(p>0.05),and the clinical data of three groups were comparable.2.Postoperative recovery: The postoperative temperature were significantly lower and the intestinal restored time were significantly shorter in the EST+LC group than these in the OCHTD group and the LC+LCBDE group(p<0.05);The usage of antibiotics and analgesics in the LC+LCBDE group was lower than that in the OCHTD group(p<0.05), but there were no statistical differences in the postoperative temperature and the intestinal restored time among the OCHTD group and the LC+LCBDE group(p>0.05).3.Surgical effects: There were three patients converted into open surpery in the LC+LCBDE group,and the rate of operation success was only 78.6%; The incidence of residual stone in the OCHTD group reached 20%,and it was significantly higher than the EST+LC group and the LC+LCBDE group(p<0.05);There was one patient's incision infected in the OCHTD group and a raised amylase in one patient after EST in the EST+LC group,but there was no statistical difference in the incidence of complications among three groups(p>0.05).4.Operation and hospitalization: The operation time, the blood loss, the average hospital stay and the postoperative hospital stay in the EST+LC group were significantly shorter than the OCHTD group and the LC+LCBDE group(p<0.05);The operation time in the LC+LCBDE group was longer than the OCHTD group(p<0.05), but the blood loss was significantly less than the OCHTD group(p<0.05),and there was no statistical difference in the average hospital stay and the postoperative hospital stay between two groups(p>0.05).Conclusion:EST+LC is safe, reliable and effective. Because of the advantages of less trauma, quicker recovery, fewer complications and shorter length of hospitalization time,EST+LC can be recommended to be the main method for cholecystolithiasis with choledocholithiasis; However, as long as in some selected cases, LC+LCBDE is also available .