Analysis Of Clinical Effectiveness On Two Kinds Of Minimally Invasive Treatment For Cholecystolithiasis With Choledocholithiasis

Background: Cholelithiasis is a common disease, and with the improved quality of life, diet habits and structural changes occur, the incidence of gallstones gradually increased. Foreign literature reports of common bile duct stones in patients with gallstone patients accounted for 9.2%~33.0%, and the disease often causes acute suppurative cholangitis, obstructive jaundice, gallstone pancreatitis, shock and even lead to death. The choice of biliary anatomy with minimal impact on the best surgical treatment, less side effect, now has become a hot problem of hepatobiliary surgeons. With the continuous development of the technology of minimally invasive surgery and technical level of medical imaging and improve, appeared a lot of surgical methods about the treatment of cholecystolithiasis and choledocholithiasis. It is very important for the comparsion of ERCP/EST+LC and LC+ LCBDE+ PS in the clinical efficacy.Objective: To explore the endoscopic retrograde cholangiopancreatography / endoscopic sphincterotomy(ERCP/EST) + laparoscopic cholecystectomy(LC) and laparoscopic cholecystectomy(LC) + common bile duct exploration(LCBDE)+Primary suture(PS) in treatment of cholecystolithiasis and choledocholithiasis advantages and disadvantages and indications, to seeking a more reasonable scheme of operation in two kinds of minimally invasive treatment modalities.Methods : This research has chosen 60 cases of cholecystolithiasis and choledocholithiasis patients who had accept operation treatment from 2013 august to 2015 december in Department of hepatobiliary pancreatic surgery,First Hospital of Jilin University. According to the operation method,the patients were divided into A and B groups. The A group was ERCP/EST+LC,B group was LC+LCBDE+PS. The operation time, bleeding volume, the rate of postoperative residual stones, postoperative hospital stay, the types of complications, and the cost of hospitalization were compared. And all the date were reviewed and analyzed.Result: The intraoperative situation:Two groups of patients with operation time, bleeding volume had no significant difference(P>0.05). After the operation:Two groups of patients with the rate of postoperative residual stones had no significant difference(P>0.05).Two groups of patients with postoperative hospital stay, the types of complications, and the cost of hospitalization had exist significant difference(P<0.05).Conclusion: 1. ERCP/EST+LC and LC+LCBDE+PS are safe, effective and feasible in the treatment of cholecystolithiasis with choledocholithiasis. 2. When the patients in good general condition, preoperative imaging examination showed that there was no intrahepatic bile duct stones, common bile duct diameter greater than 0.8 cm, intraoperative take net calculi, unobstructed access to the lower end of the common bile duct and no obvious inflammation, LC + LCBDE + PS is the preferred method of treatment. 3. When the patients with poor health, elderly, accompanied by major organ diseases, especially in patients with a high risk of suppurative cholangitis, ERCP/EST+LC is the preferred method of treatment. 4.The implementation of primary suture needs endoscopic technology to escort, and need surgeons skilled at choledochoscope, laparoscopic biliary suture technique.