Comparison Of Clinical Effects Between Two-endoscope Surgery (Laparoscope+Choledochoscope) And Endoscopic Retrograde Cholangiopancreatography (ERCP) For Elderly Patients With Simple Choledocholithiasis

Objective: To compare the clinical effects of elderly patients with simple choledocholithiasis treated by two-endoscope surgery(laparoscope + choledochoscope)and endoscopic retrograde cholangiopancreatography(ERCP).Methods: The clinical data of 59 elderly patients with simple choledocholithiasis from Jan.2016 to Dec.2020 were collected and analyzed retrospectively.According to the surgery way,it was divided into two group,patients in group A(n=32)received two-endoscope surgery(laparoscope + choledochoscope)and others in group B(n=29)received ERCP.Comparative studies on preoperative baseline data(such as gender,age,common bile duct diameter,stone diameter,single/multiple choledocholithiasis,preoperative biliary pancreatitis,history of cholecystectomy/biliary duct surgery,hypertension,diabetes,heart disease,preoperative white blood cells count,preoperative albumin,preoperative total bilirubin,preoperative aminotransferase,preoperative creatinine),duration time of abdominal drainage tube,postoperative hospital stay,total hospitalization costs,stone residual rate,stone recurrence rate,and total postoperative complications(such as incision infection,bile leakage,biliary tract infection,pulmonary infection)were made.Results: Preoperative general data of the two groups were compared,the proportion of patients with history of cholecystectomy/biliary duct surgery in group A was 90.6%,which was significantly higher than48.1% of the group B(P≤0.05),while there was no statistically significant difference in other preoperative general datas(P>0.05).The postoperative hospital stay and total hospitalization costs in group A was(4.34±2.11)days,(27306.66±9466.93)yuan,which was significantly shorter or less than(5.93±1.59)days,(36013.77±12683.75)yuan in the group B(P≤0.05).The total hospital stay and duration time of abdominal drainage tube in group A was(10.91±7.06)days,(3.58±1.36)days,which was no statistically significant difference than(12.93±5.72)days,(3.44±1.15)days in the group B(P>0.05).The total postoperative complications in group A was12.5%(1 incision infection,1 bile leakage,2 pulmonary infection),which was no statistically significant difference than 7.4%(1 biliary tract infection,1 pulmonary infection)in group B(P>0.05).After treatment,the stone residual rate in group A was 3.1%,which was no statistically significant difference than 7.4% in group B(P>0.05).Patients in both groups were followed up for 3 months to 5 years,and the follow-up rate was 90%,the stone recurrence rate in group A was 9.4%,which was no statistically significant difference than 7.4% in group B(P>0.05).Conclusions: Two-endoscope surgery(laparoscope + choledochoscope)treatment of simple choledocholithiasis in the elderly patients can significantly shorten the postoperative hospitalization time and reduce the total cost of hospitalization,and the efficacy is definite,safe and reliable.