| ObjectivesTo analyze the efficacy and safety of different timing of ERCP combined with LC surgery for patients with cholecystolithiasis with choledocholithiasis,with particular focus on the change of inflammatory markers and the difference of LC surgical difficulty in order to provide reliable reference for finding the optimal timing for the highest comprehensive benefit of the patients.MethodsA retrospective analysis of clinical data of patients with cholecystolithiasis with choledocholithiasis treated with ERCP combined with LC from January 2016 to December 2020 in Su Bei People’s Hospital was performed,and 497 patients were screened out.According to whether ERCP and LC were completed during the same operation,the patients were divided into two groups: the concurrent surgery group and the staged surgery group.According to the interval between ERCP and LC surgery,the staged surgery group was further divided into the early surgery group(LC was performed 1-6 days after ERCP)and the delayed surgery group(LC was performed7-14 days after ERCP).We compared the completion rate,outcome,postoperative complications,hospital stay and cost of the same-time surgery group and staged surgery group,as well as the early and delayed surgery group,with a focus on the degree of gallbladder adhesion during LC and the incidence of LC surgical difficulty.For the early and delayed surgery groups,the changes of preoperative and postoperative biochemical indicators were analyzed and compared between the two groups.1.Baseline data:A comparison between the concurrent surgery group and the staged surgery group,the early surgery group and the delayed surgery group was made in terms of age,gender,BMI,liver function classification,complications,accompanying symptoms and preoperative imaging examinations,with no statistically significant difference(P>0.05).2.Completion of the operation:16 patients in the concurrent surgery group and 7patients in the staged surgery group failed repeatedly to cannulate in ERCP,and the stone was extracted through choledochotomy or re-ERCP for stone removal;3 cases of ERCP stone recurrence occurred in the staged surgery group,and a second ERCP for stone removal and planned LC were performed;2 LC cases of the staged surgery group underwent open surgery.3.Comparison of surgical effects:The degree of gallbladder adhesion and the rate of difficult LC in the concurrent surgery group were significantly lower than those in the staged surgery group(5.3% vs 13.4%),and the total operation time(90 minutes vs 80 minutes)and the intraoperative gallbladder diameter(11cm vs 9cm)were significantly longer than those in the staged surgery group(P<0.05).In the staged surgery group,the rate of difficult LC was lower in the early surgery group than that in the delayed surgery group(9.2% vs 20.3%),and the difference was statistically significant(P<0.05).There were no statistical differences in pancreatic insertion rate,pancreatic stent placement rate,intraoperative blood loss,biliary tract injury rate,and abdominal drainage tube placement rate between the concurrent surgery group and the staged surgery group,and the early surgery group and the delayed surgery group(P>0.05).4.Comparison of postoperative complications:The overall incidence of postoperative complications between the concurrent surgery group and the staged surgery group was 21.5%(73/340)and 21.7%(34/157).The overall incidence of postoperative complications between the early surgery group and the delayed surgery group was Results19.4%(19/98)and 25.4%(15/59).There was no statistical difference in the incidence of complications among the groups(P > 0.05).5.Comparison of postoperative data:The postoperative NRS score,total hospital stay,postoperative recovery time and total hospital charges in the concurrent surgery group were significantly lower than those in the staged surgery group,with 11(9,14)and 14(12,17)days for total hospital stay,6(5,7)and 10(9,12)days for postoperative recovery time,and 3.12(2.78,3.53)and 3.32(2.99,3.73)million yuan for total hospital charges respectively,and the differences were statistically significant(P<0.05).In the staged surgery group,the early surgery group had lower total hospital stay,postoperative recovery time,and total hospital charges than the delayed surgery group,with 13(11,15)and 17(15,21)days for total hospital stay,10(8,11)and 13(11,16)days for postoperative recovery time,and 3.23(2.91,3.61)and 3.46(3.13,3.96)million yuan for total hospital charges respectively,which showed significant statistical differences(P<0.05).6.Comparison of biochemical indices between the early surgery group and the delayed surgery group :The early surgery group had a significantly higher postoperative WBC,N,NLR than preoperative values,and these WBC,N,NLR were significantly higher than that of the delayed surgery group,with statistically significant differences(P<0.05).When comparing the hepatic function parameters between both groups,no statistically significant differences were found(P>0.05).Conclusions1.For patients with cholecystolithiasis with choledocholithiasis,concurrent surgery is associated with lower postoperative pain scores,hospitalization time and cost than staged surgery after ERCP.2.Comparison between early(1-6 days)and delayed(7-14 days)LC after ERCP,although the level of postoperative inflammatory markers is higher in early group,hospitalization time and cost are lower and no increase in postoperative complication rate.3.Tissue adhesion around gallbladder will gradually increase in 14 days after ERCP and the difficulty of LC will also increase.4.For patients with cholecystolithiasis with choledocholithiasis,ERCP combined with LC treatment during the same operation is recommended;if conditions do not permit,LC can be arranged within 1-6 days after ERCP. |
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