Discussion Of Different Surgical Methods For Secondary Choledocholithiasis

Object: To investigate the effect,safety and indications of laparoscopic cholecystectomy(LC)Combined with previous endoscopic retrograde cholangiopancreatography(ERCP)and laparoscopic transcystic common bile duct exploration(LTCBDE)on secondary choledocholithiasis.Method: We retrospective analyzed 69 patients with secondary common bile duct stones who were admitted between January 2014 to June 2016 in Second Hospital of Hebei Medical University hospital.All patients underwent ultrasonography,upper abdominal CT or MRI and were diagnosed secondary choledocholithiasis.According to different surgical methods,patients were divided into two groups,namely: observation group(LC+LTCBDE)and control group(ERCP+LC).General information difference of patients in each group was not statistically significant,and two different methods was adopt to the patients with gallbladder stones and secondary choledocholithiasis.Preoperative and postoperative liver function(total bilirubin,direct bilirubin,albumin,alanine aminotransferase,alkaline phosphatase,γ-GGT,(gamma glutamy-transpeptidase),electrolyte(serum sodium,serum potassium,serum chloride),operation time,intraoperative blood loss,hospital stay and total fasting time were monitored.And postoperative complications,the incidence of residual stones,length of hospital stay,length of total cost,and stone recurrence was studied.The data was analyzed by SPSS19.0 and the measurement data in this study was expressed as mean X ±S.T-test was applied and the acceptance of the statistical significance level was P< 0.05.We investigated the advantages and disadvantages of both LC+LCTBDE and ERCP+LC on gallbladder stones and secondary choledocholithiasis.And we discussed the clinical value of the two methods.Result: 24 patients in the observation group underwent LC+LTCBDEsurgery without any complications such as biliary fistula,bile duct bleeding,acute pancreatitis,or acute peritonitis.And the average operation time was124.83±33.02 minutes while intraoperative blood loss 22.13±18.82 ml,hospital total water fasting time 51.00±8.11 hours,length of hospital stay11.25±2.80 d,hospitalization cost 19997.05±5089.71 Yuan.Residual stones were found in one case in LTCBDE group(4.17%,1/24).Postoperative were treated with,no common bile duct stones recurrence in the observation group during a 6~20 months of follow-up.All 45 cases in the control group underwent ERCP+LC successfully.High blood amylase were found in 8 cases(17.78%,8/45)and postoperative ERCP pancreatitis(PEP)in 3 cases(6.67%,3/45).4 in 32 cases found common bile duct stones by postoperative nasal cholangiopancreatography which means the eject rate of stones 8.89%(4/45).No severe complications such as perforation,hemorrhage,acute severe cholangitis and severe acute pancreatitis.Operation time was 119.09±38.26 minutes in the control group while intraoperative blood loss 31.69 ± 53.50 ml,hospital total level of fasting 74.13 ± 22.20 hours,length of hospital stay 16.47± 3.92 days,hospitalization expenses 36886.07 ± 8778.20 Yuan.1 case in the control group suffered from recurrence common bile duct stones after 2months and 1 case after 12 months during a 6 ~ 20 months follow-up.Study showed that total water fasting time,length of hospital stay and hospital costs were significantly different in the two groups(P<0.01);The operation time,intraoperative blood loss,postoperative function,electrolyte index contrast difference were not obvious(P > 0.05).Postope-rative alkaline phosphatase,gamma glutamy-transpeptidase were significantly different between the two groups(P<0.05).Conclusion: This study shows that LC+LTCBDE operation method in the treatment of secondary choledocholithiasis has the advantages of smaller damage,faster water hospitalization time,shorter hospitalization time,lower cost,lower complication rate.LCTBDE for secondary choledocholithiasis could be broadcast as a less invasive method.