The Clinical Application Of Gallbladder-Preserved Treatment Of Cholecystolithiasis And Choledocholithiasis With Three Endoscopes

Objective To evaluate the effect and feasibility of the gallbladder-preserved treatment in cholecystolithiasis and choledocholithiasis with three endoscopes, combined duodenoscope, laparoscope, and choledochoscope. To investigate the new minimally invasive surgical treatment in cholelithiasis.Methods From January 2010 to April 2015,52 patients with choledocholithiasis associate with cholecystolithiasis in the first affiliated hospital of Guangxi medical university were recruited. First of all, all 52 patients were underwent endoscopic retrograde cholangiopancreatography(ERCP), endoscopic sphincterotomy(EST) and endoscopic nasobiliary drainage(ENBD).After the above theatment,22 cases were underwent endoscopic minimally invasive cholecystolithotomy(EMIC group),the other 30 cases were underwent laparoscopic cholecystectomy (LC group). Comparison was done between the two groups, including time of operation, intraoperative amount of bleeding, postoperative time of anal exhaust, postoperative hospital stays, post-discharge complications, postoperative recurrence rate of choledocholithiasis,post-discharge and quality of life.Results All operations for two groups were performed successfully and recovered well after operations. No significant differences were displayed between the two groups postoperative time of anal exhaust (P>0.05). The operation time and the intraoperative amount of bleeding, postoperative recurrence rate of choledocholithiasis of EMIC group is shorter than that of LC group (P<0.05). After surgery,2 groups were followed up. The recurrence rate of choledocholithiasis of LC group is 13.3%,and EMIC group can not find any evidence of recurrence of choledocholithiasis. The recurrence rate of cholecystolithiasis of EMIC group is 4.5%. Six mouthes after discharged, 17 cases of LC group suffered diarrhoea, dyspepsia,or midsection pain. But in EMIC group, there were only 3 patients experienced the same discomfortable symptom (P<0.05).One years after discharged,10 cases of LC group still had these symptoms. In EMIC group, there were 2 cases experienced (P<0.05).Conclusion Based on the result, we think that the new method of gallbladder-preserved treatment of cholecystolithiasis and choledocholithiasis is safe and feasible. Meanwhile, this treatment can improve the patient’s quality of life.