Mini-invasive Treatment For Cholecystolithiasis Complicated With Non-dilated Choledocholithiasis

Objective:Due to the westernization of dietary habits and the reduction of physical activities,the prevalence of gallstone disease among Chinese population has increased in recent years,and there is a trend of younger generation.With the improvement of surgical skills,technological progress,social and economic development,more and more patients tend to choose minimally invasive surgery,and traditional surgical operations are gradually moving towards minimally invasive surgery.At present,there is still much controversy on the selection and indications of the treatment of cholecystolithiasis complicated with non-dilated choledocholithiasis,which is also the difficulty in clinical work.This artical aims to summarize the data,characteristics,surgical methods and indications of patients with cholecystolithiasis complicated with non-dilated choledocholithiasis in our department,and to explore the minimally invasive treatment of cholecystolithiasis complicated with non-dilated choledocholithiasis.Method:According to the inclusion and exclusion criteria,a retrospective analysis of the clinical data of 85 patients in the Department of Hepatobiliary and Pancreatic Surgery,the First Hospital of Jilin University from January 2018 to January 2021 who were received surgical treatment of cholecystolithiasis complicated with non-dilated choledocholithiasis.The treatment methods included endoscopic retrograde cholangiopancreatography(ERCP)+synchronous LC,ERCP+nonsynchronous LC,laparoscopic transcyctic duct common bile duct exploration(LTCBDE).The statistical data were general preoperative data included age,weight,common bile duct diameter,and common bile duct stone diameter.Intraoperative data included operation time,intraoperative blood loss,and whether the operative method was changed.Postoperative data included postoperative hospitalization time,total hospitalization cost,gastrointestinal recovery time.Postoperative complications including biliary leakage,postoperative hemorrhage,biliary tract infection,hyperamylasemia,acute pancreatitis,and secondary lithotomy.The laboratory examination of preoperative,postoperative 1 day and postoperative 3 days included white blood cell count(WBC),γ-glutamyl transpeptidase(γ-GT),alkaline phosphatase(AKP),serum total bilirubin(TBil)and serum amylase(AMS).The comparison between the data uses Kruskal-Wallis H test rank sum test,analysis of variance,X~2-test,and SPSS 26.0 software for statistical processing.Results:Preoperative general information:There were no significant differences in age,weight,common bile duct diameter and common bile duct stone diameter in the LTCBDE group,the ERCP+synchronous LC group and the ERCP+nonsynchronous LC group.Intraoperative data:There was no significant statistical difference in the three groups in terms of intraoperative blood loss and the change of surgical method.In terms of operation time,there was a statistical difference in the LTCBDE group<ERCP+synchronous LC and ERCP+nonsynchronous LC(P<0.05).Postoperative information:In terms of postoperative hospital stay and total hospitalization cost,LTCBDE group<ERCP+synchronous LC<ERCP+nonsynchronous LC,there was a statistical difference(P<0.05).In terms of postoperative recovery time of gastrointestinal function,the patients in the ERCP+nonsynchronous LC group were higher than those in the LTCBDE group and ERCP+Synchronous LC group,and there was a statistical difference(P<0.05).In terms of total postoperative complications,there was no statistical difference between the three groups.In terms of laboratory examination,the preoperative serum total bilirubin(TBIL)in ERCP+nonsynchronous LC group was lower than that of ERCP+synchronous LC group,there was a statistical difference(P<0.05).The preoperative serum amylase(AMS)of the ERCP+nonsynchronous LC group was the highest.The serum amylase(AMS)of the LTCBDE group was the lowest at 1 and 3 days after the operation.The AMS of the ERCP+nonsynchronous LC group was lower than that of the ERCP+synchronous LC group at 3 days after operation,there was a statistical difference(P<0.05).Conclusions:LTCBDE,ERCP+synchronous LC,and ERCP+nonsynchronous LC can all effectively treat the cholecystolithiasis complicated with non-dilated choledocholithiasis.LTCBDE compared with ERCP+synchronous LC and ERCP+nonsynchronous LC can reduce the operation time,postoperative hospitalization time,total hospitalization cost.The patient has the characteristics of lower serum amylase level and faster recovery of gastrointestinal function after surgery.Through rigorous preoperative evaluation and strict control of surgical indications,LTCBDE has advantages in the treatment of the cholecystolithiasis complicated with non-dilated choledocholithiasis.Compared with the ERCP+nonsynchronous LC,ERCP+synchronous LC can reduce the postoperative hospital stay,reduce the total hospitalization cost,and reduce the patient’s gastrointestinal function recovery time.