Clinical Efficacy Of LC+LCBDE And EST/EPBD+LC In The Treatment Of Cholecystolithiasis Complicated With Common Bile Duct Stones

Background and Purpose:Cholelithiasis is a common disease in our life.The incidence of cholelithiasis varies from place to place around the world.According to the second cholelithiasis survey data of 3911 surgical cases in 7 provinces and cities in China in 1995 [1] :inpatients with cholelithiasis accounted for 11.53% of the total number of general surgery in the same period;the ratio of female to male was 2.57:1;patients with simple cholelithiasis accounted for 60%;patients with cholelithiasis combined with common bile duct stones accounted for about 20%.With the improvement of living standards and the progress of diagnosis and treatment technology,its incidence and diagnosis rate have increased.The clinical manifestations of cholelithiasis are abdominal pain,chills,high fever,jaundice and so on.In addition,choledocholithiasis obstruction may cause secondary suppurative cholangitis,systemic infection,liver damage,and biliary pancreatitis.At present,there are many treatment methods for cholecystolithiasis complicated with choledocholithiasis,but the main treatment is through surgery.For example: open cholecystectomy + common bile duct exploration,Endoscopic retrograde cholangiopancreatography(ERCP)/Endoscopic Sphincterotomy(EST)/Endoscopic Papillary Balloon Dilatation(EPBD)+ Laparoscopic Cholecystectomy(LC),Laparoscopic Common Bile Duct Exploration(LCBDE)+ Laparoscopic Cholecystectomy(LC).Postoperative treatment methods of laparoscopic exploration are different,including T tube drainage,one-stage suture,biliary stent and other methods.The principle of treatment is to remove the stone,remove the obstruction,smooth drainage.But which approach has the advantage remains a matter of debate.This paper retrospectively analyzed the clinical data of patients with cholecystolithiasis complicated with common bile duct stones admitted to our hospital from January 1,2017 to December 31,2019.To summarize the efficacy differences and advantages of EST/EPBD+LC and LC+LCBDE in minimally invasive treatment,and to provide a preliminary basis for the treatment of patients with choledocholithiasis combined with gallbladder combination.Materials and methodsThis paper retrospectively analyzed the case data of patients with cholecystolithiasis complicated with common bile duct stones admitted to Jingzhou First People’s Hospital from January 1,2017 to December 31,2019.who met the inclusion criteria: 122 cases;LC+LCBDE+T tube drainage group: 54 cases,EST/EPBD+LC: 68 cases.Basic data of patients.The author made a comparative analysis on the basic data of the patients,operation conditions,hospitalization conditions and postoperative complications.Results:There were no significant differences in age,gender,chronic disease,common bile duct diameter,size and number of common bile duct stones between LC+LCBDE group and EST/EPBD+LC group between the 2 groups(P>0.05).The rate of stone removal was 90.07% in LC+LCBDE group and 89.70% in EST/EPBD+LC group,but the difference was not statistically significant(P>0.05).The conversion rate of laparotomy was 5.88% in the LC+LCBDE group and 5.55% in the EST/EPBD+LC group,with no significant statistically significant difference(P>0.05).Operation time(m)(108.4±12.9vs134.71),intraoperative blood loss(ml)(16.51±4.64vs25.38±5.78)and postoperative exhaust time(h)(23.91±5.17vs45.21±6.89): EST/EPBD +LC group was superior to LC+LCBDE group,and the difference was statistically significant(P<0.05).The hospitalization cost of LC+LCBDE group was less than EST/EPBD+LC,and the difference was statistically significant(P<0.05).2 groups in the incidence of postoperative hospital stay,postoperative complications,the total no significant differences(P>0.05),but the incidence of postoperative pancreatitis LCBDE group1.85%(1/54)than EST/EPBD group 10.29%(7/68),statistically significant difference(P<0.05),postoperative bile leakage LCBDE group 9%(5/54)higher than EST/EPBD1.47%(1/68),the difference is statistically significant(P<0.05).Conclusion:Both of the two methods are safe and effective in the treatment of cholecystolithiasis complicated with common bile duct stones.There was no significant difference in the total incidence of postoperative complications between the two methods,but both of them had their own surgical characteristics.The LC+LCBDE group had a relatively better hospitalization cost,but a higher risk of bile leakage than EST/EPBD,while the operative time and intraoperative blood loss of EST/EPBD+LC were relatively better,but the incidence of pancreatitis was higher than LCBDE.