Application Of Accelerated Rehabilitation Surgery In The Treatmentof Cholecystolithiasis Complicated With Choledocholithiasis By Laparoscopy And Choledochoscopy

Objective:To investigate the application value of accelerated rehabilitation surgery(Enhanced after recovery surgery,ERAS)in the perioperative treatment of cholecystolithiasis complicated by choledocholithiasis by laparoscopic choledochoscopy.Methods:A total of 122 patients who met the standards of cholecystolithiasis combined with choledocholithotomy in the Department of Hepatobiliary and Pancreatic Surgery of our hospital from January 2016 to December 2019 were selected,and all of them were operated by Laparoscopic cholecystectomy(LC)combined with Laparoscopic choledocholithotomy and intraoperative t-tube drainage(LCHTD).A total of 60 patients in ERAS group were treated with perioperative management of ERAS;In the control group,62 cases were treated with traditional perioperative management mode.The preoperative general conditions of patients inthe two groups were observed:gender,age,Body mass index(BMI),preoperative liver function grade;Surgical situation:Operation time,intraoperative blood loss;Postoperative recovery indicators of patients in the two groups:first postoperative exhaust time,first postoperative bed time,drainage tube removal time,postoperative C-reactive protein(CRP),postoperative pain score(Visual analogue scale,VAS);The incidence of postoperative complications:vomiting,incision infection,pulmonary infection,urinary tract infection,biliary fistula;Duration of postoperative hospitalization and hospitalization cost.Results:1.There were no statistically significant differences in age,gender,BMI,preoperative liver function grade,operative time and intraoperative blood loss between the two groups(P>0.05).2.The first postoperative exhaust time,the first time to get out of bed and the drainage tube removal time in ERAS group were significantly shorter than those in the control group,with statistical significance(P<0.001).3.Compared with the control group,the postoperative hospital stay and hospitalization cost in ERAS group were significantly decreased,with statistical significance(P<0.001).4.Repeated measurement ANOVA showed that there was no significant difference in preoperative CRP between ERAS group and control group(P>0.05).The CRP level at postoperative day 1,3 and 5 was significantly lower than that in the control group,and the difference was statistically significant(P<0.001).5.Repeated measurement analysis of variance showed that postoperative VAS score in ERAS group was lower than that in control group at 24 h,48h and 72 h after surgery,with statistical significance(P<0.001).6.There was no statistical significance in the incidence of vomiting,incision infection,pulmonary infection,urinary tract infection,biliary fistula and other complications between the two groups(P>0.05).The incidence of total complications in ERAS group(3.3%)was lower than that in control group(16.1%),and the difference was statistically significant(P<0.05).Conclusion:1.The ERAS concept is safe and effective in the perioperative application of laparoscopy combined with choledochoscopy in the treatment of gallbladder stones combined with choledocholithiasis.2.The ERAS concept applied to the perioperative period of laparoscopy combined with choledochoscopy for the treatment of gallstones combined with choledocholithiasis can effectively shorten the hospital stay,reduce hospitalization cost,save medical resources,and accelerate the recovery process of patients.