Clinical Study On The Treatment Of Extrahepatic Bile Duct Stones

Part 1 Comparison of Laparoscopic One-stage and Two-stage Management in the Treatment of Gallstones with Common Bile Duct StonesObjectiveWe have reviewed the basic situation of patients who are treated with one-stage or two-stage management because of gallbladder stones and common bile duct stones,and compared the clinical efficacy,cost-effectiveness and complications of the two surgical strategies,to explore the optimal management for patients without severe or acute complications of cholelithiasis.MethodsPatients of cholelithiasis who are treated for laparoscopic common bile duct exploration(LCBDE)followed by laparoscopic cholecystectomy,or endoscopic retrograde cholangiopacretatography(ERCP),endoscopic sphincterotomy followed by laparoscopic cholecystectomy from the Second Hospital of Lanzhou University in nearly three years have been admitted.We compares patients’ white blood cells,neutrophils percentage,liver function,bile enzyme,treatment cost,postoperative tube day,hospital stay,bile drainage and other indicators of efficacy and postoperative complications between two groups.Results1.Baseline data: Except that the patients in the one-stage group are younger than two-stage group,there are no statistical differences in the general information and preoperative indicators between the two groups,and the baselines are same and comparable.2.Clinical effects: Between the two surgical methods,the WBC in the one-stagegroup decreases faster(P﹤0.05),and the cost of hospitalization(P﹤0.05)is less.In the two-stage management group,the total bleeding volume(P ﹤ 0.05)during operation is less,the total operation time(P﹤0.05)is shorter,gastrointestinal function recoveries faster(P﹤0.05),and postoperative tube-carrying time(P﹤0.05)is shorter.Patients can be discharged earlier after surgery(P﹤0.05),the success rate of both groups is similar.3.Postoperative complications: There are no differences between the two groups in terms of number of blood transfusion,incision infection,lung infection,and recurrence.While,the rate of ERCP-related pancreatitis(P ﹤ 0.05)and hyperamylaseemia(P ﹤ 0.05)is higher in the two-stage group.The complications such as electrolyte disturbances,conversion to open surgery are also similar.ConclusionRegarding the treatment for patients of common bile duct stones with gallbladder stones without severe and acute complications,one-stage management is better than two-stage management in terms of treatment costs,postoperative pancreatitis,hyperamylaseemia and other postoperative complications,although two-stage management may shorten the operation time,the postoperative hospital stay,and promote gastrointestinal function recovery.Part 2 A Meta Analysis of The Comparison of Indwelling Nasobiliary Duct and T-tube in The Laparoscopic Treatment of CholedocholithiasisObjective The aim of the present study is to compare endoscopic nasobiliary drainage(ENBD)with T-tube drainage for patients of common bile duct stones in their management of laparoscopic common bile duct exploration(LCBDE),in order to build some basis for treatment.Methods A comprehensive search is performed in the Pub Med,EMBASE,The Cochrane Library,WANGFANG,CNKI,and CBM databases,including study published from1960 to 2019.The filter is made according to the inclusion inclusion and exclusion criteria,and all calculations and statistical tests are performed using Rev Man 5.3software.Results1.Literature search results:A total of 9 randomized controlled trials(RCTs),17 case-control studies are included.There are totally 2098 patients in the study,including 1114 patients with endoscopic nasobiliary drainage,984 patients with T-tube.2.Clinical effects: ENBD drainage has advantages in terms of postoperative gastrointestinal function recovery time(WMD ﹦-17.80,95%CI:-31.11 ~-4.48,P﹤0.05),postoperative hospital stay(WMD﹦-6.53,95%CI:-8.64~-4.43,P﹤0.05),carrying tube time(WMD﹦-46.01,95%CI:-83.64~-8.37,P ﹤ 0.05).However,significant differences are not found between the two management on operative time,intraoperative blood loss,treatment cost.3.Postoperative complications: ENBD drainage has lower rate of postoperative biliary fistula(OR ﹦ 0.5,95%CI:0.28 ~ 0.89,P ﹤ 0.05),wound infection(OR﹦ 0.35,95%CI:0.17~0.73,P﹤0.05).There is no difference between the two managements on retained stones.Conclusion For patients of extrahepatic bile duct stones who cannot be removed by endoscopy,LCBDE combined with preoperative and intraoperative ENBD tube can significantly shorten recovery time and tube time,reduce postoperative complications,and has lower risk of postoperative pancreatitis and hyperamylaseemia,so it is worthy of promoting in clinical.