| Objective:Choledocholithiasis is a common clinical biliary disease which often accompanied by cholecystolithiasis.In last several years,along with the intensification of social aging and the continuous improvement people’s living standards,the prevalence of choledocholithiasis with cholecystolithiasis among the old is also on the rise.As of now,there are 2 widely accepted standard approaches for the management of cholecysto-choledocholithiasis:laparoscopic cholecystectomy(LC)combined laparoscopic common bile duct exploration(LCBDE),and endoscopic retrograde cholangiopancreatography(ERCP)followed by LC.However,older patients are more likely to suffer from higher general anesthetic risk owing to the influence of many underlaying disease and more intricate clinical situations.Ursodeoxycholic acid(UDCA),the only drug approved by the Food and Drug Administration(FDA)for non-surgical treatment of gallstones,has been proved to be effective in dissolving gallstones.The study was performed to investigated the curative effects of endoscopic retrograde cholangiopancreatography(ERCP)combined with ursodeoxycholic acid(UDCA)and other two mainstream therapies in the treatment of patients over 75 with choledocholithiasis complicated with cholecystolithiasis,and to analyze factors affecting quality of life after surgery.Methods:Clinical data of 184 elderly patients(age≥75 years)with choledocholithiasis and cholecystolithiasis treated in Shandong Provincial Hospital during June 2017 and June 2019 were retrospectively analyzed.According to the treatment options,the patients were divided into ERCP+UDCA group with 66 patients,laparoscopic cholecystectomy(LC)+laparoscopic common bile duct exploration(LCBDE)group with 64 patients,and ERCP+LC group with 54 patients.The general data,short-term and long-term complications,and surgical condition were compared,and the Gastrointestinal Quality of Life Index(GIQLI)scale was used to assess life quality two years after surgery.Multinomial Logistic regression model was used to explore the independent factors of GIQLI scale two years after operation.Results:The three groups were comparable in age,sex,stone number and previous history(P>0.05).There were statistically significant differences among the ERCP+UDCA group,LC+LCBDE group and ERCP+LC group in operation time[43.0(37.0,61.8)vs 200.0(170.0,243.8)vs 189.0(172.0,215.5)min],hospitalization costs[31.9(27.1,38.0)vs 45.8(38.1,52.5)vs 54.4(48.6,65.2)thousand yuan],hospital stay[(6.0(5.0,8.8)vs 10.5(8.0,12.0)vs 13.0(9.0,15.5)d)and time to extraction of drainage tube[3(2,4)vs 30(28,30)vs 4(4,7)d),all P<0.001.Compared with the other two groups,the ERCP+UDCA group had shorter operation time,hospital stay and extraction of drainage tube,and lower hospital costs(all P<0.05).There were no significant differences in the rate of surgical success,postoperative catheterization,incidence of short-term and long-term complications,and GIQLI score among the three groups(all P>0.05).Age increase and postoperative complications were independent risk factors affecting GIQLI scale 2 years after surgery.Conclusion:1.ERCP+UDCA、LC+LCBDE and ERCP+LC are all safe and effective for patients over 75 with choledocholithiasis complicated with cholecystolithiasis.ERCP+UDCA could effectively control the disease without reducing elderly patients’ quality of life,which maybe an effective,safe and simple treatment for elderly patients with satisfactory gallbladder contractile function and high risk of surgery.2.Age increase and postoperative complications were independent risk factors affecting patients’ postoperative quality of life,suggesting that we need to improve medical standards and promote early detection,early diagnosis and early treatment of disease to minimize the occurrence of postoperative complications and improve elderly patients’ postoperative quality of life.3.Comprehensive therapy and individualized treatment based on the characteristics of the disease should be carried out in clinical treatment instead of performing the LC blindly. |
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