Analysis Of The Curative Effect Of Combined LC Treatment On Patients With Gallbladder Stones Combined With Common Bile Duct Stones At Different Times After ERCP

Background:Gallstone disease(GD,Gallstone disease)is a common disease of the digestive system that may cause a variety of characteristic clinical manifestations caused by a variety of factors.As one of the most common diseases in hepatobiliary surgery,the incidence of GD in the world can be as high as 10%,and the incidence of middle-aged women can reach 15%.Among them,the probability of having both gallbladder stones(GS)and common bile duct stones(CBDS)is approximately 12% to20%.Before the concept of minimally invasive and minimally invasive technology has not yet been widely popularized,open surgery methods,namely open cholecystectomy(OC)+ common bile duct exploration(CBDE)+ T tube drainage often be applied to the surgical operation of GS combined with CBDS.With the continuous development and advancement of the minimally invasive technologies,the treatment of such diseases has gradually changed to laparoscopy combined with choledochoscopy,or laparoscopy combined with duodenoscopy.At present,more and more qualified medical centers combine endoscopic retrograde cholangiopancreatography/endoscopic duodenal papillary sphincterotomy(ERCP/EST)with Laparoscopic cholecystectomy(LC)and regard it as the first choice for the treatment of patients with both GS and CBDS.However,in the international medical community,there is still much controversy about the optimal time interval between ERCP/EST and LC.This study intends to retrospectively analyze the clinical data of patients with both GS and CBDS,and on this basis,further study the perioperative related indicators,preoperative and postoperative liver function related indicators and postoperative complication rate effects of combined LC treatment at different times after ERCP/EST operation in patients with both gallstones and common bile duct stones.To provide theoretical support and help for the choice of the timing of LC surgery after ERCP in patients with both GS and CBDS.Methods:Collect the clinical data of all patients who underwent ERCP/EST combined with LC for the treatment of GS and CBDS in the Department of Hepatobiliary and Pancreatic Surgery of Qingdao Municipal Hospital(Eastern District)from September2017 to September 2019,and selected by inclusion and exclusion criteria.A total of152 cases that met the criteria were retrospectively analyzed.According to the different intervals of ERCP/EST combined with LC,the selected patients were divided into 3 groups,namely: Group A: ERCP/EST combined with LC on the same day;Group B: 1~2 days after ERCP/EST combined with LC;C Group: 3~7 days after ERCP/EST surgery combined with LC.The total hospitalization time,total hospitalization cost,operation time,intraoperative blood loss,liver function related indicators(ALT),aspartate aminotransferase(AST)before and after operation were compared between the two groups of patients,total bilirubin(TBil),γ-glutamyl transpeptidase(γ-GGT)),postoperative complications including biliary fistula,acute pancreatitis(AP),Bleeding,infection,hyperamylaseemia incidence rate,stone clearance rate and other indicators are summarized and analyzed to provide some theoretical basis for choosing the best time to combine ERCP/EST with LC.Results:1.The three groups of patients have no statistical significance in general data such as gender and age(P>0.05),and they are comparable;2.In the Group A and B,the hospitalization time(10.75±1.81 days,10.61±18,200 days),hospitalization expenses(3.11±0.21*104 yuan,3.15±0.25*104yuan),LC operation time(62.60±20.41 min,62.04±20.08min),LC intraoperative blood loss(9.33±3.52 ml,9.56±3.69ml)has no significant difference(p>0.05);however,compared with Group C(13.97±2.41 days,3.48±0.34 yuan,90.34±7.41 min,13.51±3.10ml),there is a significant difference,which is statistically significant(p<0.05);3.The liver function of Group A,B,and C have all been significantly improved compared with that before operation,the difference is statistically significant(p<0.05),compared the improvement of postoperative liver function index in Group A,B with Group C,the improvement in Group A and B is more significant than in Group C,and the difference is statistically significant(p<0.05);4.There is no significant difference in total postoperative complication and stone remaining between Group A,B and C(p>0.05).Conclusion:If the patient’s physical condition permits,LC should be combined as soon as possible after ERCP/EST surgery.This can significantly shorten the LC operation time,intraoperative blood loss,the total time of stay in hospital,and the total cost of hospitalization.Liver function and the removal of stones still can be ensured without increasing the incidence of postoperative complications.After ERCP/EST,the difficulty of LC operation may increase due to the edema of the gallbladder triangle caused by the previous ERCP/EST operation,and the degree of edema will become more serious with the increase of ERCP postoperative time,resulting in prolonged operation time and increased risk.In the clinical work,individualized treatment should be carried out according to the different conditions and requirements of different patients to determine the most appropriate timing of surgery.