Comparison Of The Curative Effect Of LCBDE And EST In The Treatment Of Choledocholithiasis

Objective:Analysis of Laparoscopic Common Bile Duct Exploration and endoscopic sphincterotomy under endoscopic retrograde cholangiopancreatography in the treatment of choledocholithiasis and postoperative complications,and compare the advantages,disadvantages and indications of the two surgical methods.Methods:Collected 157 patients with common bile duct stones who were hospitalized in the First Affiliated Hospital of Kunming Medical University from January 2017 to January 2020.They were divided into LCBDE group and EST group according to the operation method,and the following data of the two groups were compared:1.General information:gender,age,maximum stone diameter,maximum common bile duct diameter and number of stones;2.Perioperative indicators:operative time,success rate of stone removal,stone residual rate,postoperative visual analog scale(VAS),postoperative nausea or vomiting symptoms,recovery time of gastrointestinal function,length of hospital stay and hospitalization cost;3.Laboratory indicators:preoperative and postoperative values of white blood cells,total bilirubin and blood amylase and the difference between the changes before and after;4.Short-term postoperative complications:hyperamylasemia,acute pancreatitis,acute cholangitis,bile leakage,duodenal papilla hemorrhage5.Postoperative long-term complications:recurrence of calculi and reflux cholangitis,and SPSS 25.0 software package was used for statistical analysis of the above data.Results:Among the 157 patients with choledocholithiasis collected in this study,78 were males(49.7%),79 were females(50.3%),43 patients(27.4%)were aged 70 years or older,and 114 patients(72.6%)were younger than 70 years old.),77 patients in the LCBDE group and 80 patients in the EST group.(Ⅰ)Comparison and analysis of the case data between the two groups showed statistical significance(P<0.05).1.General information:Age,maximum stone diameter and maximum common bile duct diameter.In this study,most patients aged≥70 years chose EST for stone removal,while most patients with stone diameter≥1cm and common bile duct diameter≥1.5cm chose LCBDE;2.Perioperative indicators:operative time,postoperative VAS score,postoperative nausea or vomiting symptoms,length of hospital stay and hospitalization cost.Compared with the LCBDE group,the EST group had shorter operative time,less postoperative pain,nausea or vomiting symptoms,shorter length of hospital stay and lower cost;3.Laboratory indicators:postoperative values of white blood cells and blood amylase and the difference between the changes before and after surgery.The level of white blood cells and blood amylase on the first day after surgery was higher in the LCBDE group than before surgery,and the level of blood amylase on the first day after surgery was higher in the EST group than before surgery;4.Shortterm postoperative complications:hyperamylasemia and acute pancreatitis.The incidence of these two complications in the EST group was significantly higher than that in the LCBDE group.(Ⅱ)The case data of the two groups showed no statistical significance after comparative analysis,including:Gender(P=0.381),number of stones(P=0.306),success rate of stone retrieval(P=0.738),stone residual rate(P=0.253),gastrointestinal function recovery time(P=0.137),total bilirubin(P=0.223),acute cholangitis(P=0.965),bile leakage(P=0.307),duodenal papillary hemorrhage(P=0.325),stone recurrence(P=0.139)and reflux cholangitis(P=0.325).Conclusion:1.Both LCBDE and EST are safe and effective in the treatment of choledocholithiasis.ERCP has obvious advantages in postoperative subjective feelings,length of hospital stay and cost,but the incidence of postoperative hyperamylasemia and acute pancreatitis is higher.2.EST is safer and more suitable as the first choice for elderly patients with multiple underlying diseases and poor tolerance.3.LCBDE is more suitable for patients with larger stone diameter,obvious dilatation of bile duct or younger patients.4.In clinical practice,surgeons should learn from each other,strictly grasp the indications of the two surgical methods,and make individualized treatment plans for patients.