The Selection Of Minimally Invasive Treatment For Cholecystolithiasis Combined With Choledocholithiasis

Objective: To compare the efficacy of endoscopic retrograde cholangiopancreatography,papillary sphincterotomy,laparoscopic cholecystectomy,laparoscopic choledocholithotomy and cholecystectomy under different conditions,so as to provide a reference for selecting the best treatment for cholecystolithiasis with choledocholithiasis under different conditions.Methods: Clinical data of 309 patients diagnosed with cholecystolithiasis with choledocholithiasis in Hebei General Hospital from October 2016 to July 2019 were retrospectively analyzed.309 patients were divided into ERCP + EST + LC treatment group and LCBDE + LC treatment group,comparing two treatment groups in gender,age,body mass index,with or without a history of epigastric surgery,whether liver function was normal,total bilirubin level,whether merger cholangitis,common bile duct diameter size,number of common bile duct calculi and bravery manager diameter size in several cases of success rate of surgery,postoperative complications,hospital expenses and operation time.Results: 1.Under the conditions of gender,age,BMI,history of abdominal surgery,normal or abnormal liver function,total bilirubin level,and whether combined with cholangitis,the success rate of ERCP + EST + LC and LCBDE + LC was not statistically significant(P > 0.05).2.The surgical success rate of ERCP + EST + LC and LCBDE + LC was statistically significant under the conditions that the diameter of common bile duct ≥10mm,the diameter of common bile duct calculi ≤5mm,and the number of common bile duct calculi ≥3(P < 0.05).When the diameter of common bile duct was < 10 mm,the diameter of common bile duct stone was > 5mm,and the number of common bile duct stones was < 3,the surgical success rate was not statistically significant(P > 0.05).3.The overall incidence of postoperative complications of ERCP + EST + LC and LCBDE + LC was not statistically significant(P > 0.05),but the incidence of postoperative pancreatitis and bile leakage was statistically significant(P < 0.05).4.The comparison of hospitalization expenses between ERCP + EST + LC and LCBDE + LC was statistically significant(P < 0.05).5.The operative time of ERCP + EST + LC and LCBDE + LC was not statistically significant(P > 0.05).Conclusion: Both ERCP + EST + LC and LCBDE + LC are safe and effective surgical methods for the treatment of cholecystolithiasis with choledocholithiasis.However,under the conditions of bile duct diameter ≥10mm,number of calculi ≥3,and stone diameter > 5mm,LCBDE + LC has a relatively high surgical success rate in the treatment of cholecystolithiasis combined with choledocholithiasis.Therefore,it is recommended to use LCBDE + LC under such conditions.In addition,the total hospitalization cost of LCBDE + LC is lower than that of ERCP + EST + LC,which is more suitable for patients with poor economic conditions.