Clinical Study Of Two Different Surgical Methods In The Treatment Of Elderly Patients With Cholecystolithiasis And Choledocholithiasis

Objective: To compare respectively the curative effects of small endoscopic sphincterotomy plus endoscopic papillary large balloon dilatation combined with laparoscopic cholecystectomy(SEST+EPLBD+LC)and laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy(LCBDE+LC)on elderly patients with cholecystolithiasis and choledocholithiasis,and provided guidance for surgical selection of these patients.Methods: A total of 64 cases of patients with cholecystolithiasis and choledocholithiasis who were admitted to the Department of Hepatobiliary Surgery,Affiliated Hospital of Jining Medical University between January 2017 and January 2018 were retrospectively analyzed.Patients were divided into SEST+EPLBD+LC group(referred to as SEST group)and LCBDE+LC group(abbreviated as LCBDE group)according to their surgical methods.Several comparative indexes including the operation success rate,mortality rate,operation duration,intraoperative bleeding,incidence of postoperative complications,postoperative amylase changes,the rate of conversion to open surgery,length of stay and expenses were compared between two groups.Results: No statistical difference was found in the operation success rate,mortality rate,operation duration,intraoperative bleeding,postoperative complications,the rate of conversion to open surgery,the incidence ratesof residual stones,intraperitoneal infection rate,hemobilia rate,postoperative abdominal distention,and postoperative exhaust time between two groups(P >0.05).The incidence of bile leakage in the LCBDE group was higher than those in the SEST group(P <0.05)and postoperative drainage time were significantly long than those of SEST group(P <0.01).In addition,the surgical tolerance in the LCBDE group were higher than those in the SEST,and the difference was statistically significant(P<0.05).The amylase value and incidence of pancreatitis in the SEST group were higher than those in the LCBDE group(P <0.05).The costs of surgical procedure and hospitalization charges in the SEST group were higher than those in the LCBDE group(P <0.01).The blood loss of SEST group were less than LCBDE group(P <0.05).Conclusion:1.No statistical difference was found in the operation success rate and postoperative complications in the two groups.Both SEST + LC and LCBDE+LC are safe and effective therapies for cholecystolithiasis and choledocholithiasis.2.One-stage surgery of LCBDE simultaneously treated cholecystolithiasis and choledocholithiasis,and avoid the risk of secondary anesthesia to the patients.The patient's surgical tolerance in the LCBDE group were higher than those in the SEST.Meanwhile,the costs of surgical procedure and hospitalization charges in the LCBDE group were lower than those in theSEST group.Comprehensive economic conditions and patient's surgical tolerance,LCBDE is the best choice.To sum up,in the actual diagnosis and treatment process,the choice of minimally invasive treatment must be adhered to individualized treatment principles.