Clinical Study Of ERCP/EST+LC And LC+ LCBDE In The Treatment Of Gallstones Complicated With Common Bile Duct Stones

ObjectiveTo compare the clinical effects of Endoscopic Retrograde Cholangiopancreatography(ERCP)and T-tube drainage after laparoscopic common bile duct exploration(LCBDE)MethodsA total of 226 patients with cholecystolithiasis and choledocholithiasis in Shangqiu first people’s Hospital from January 2015 to January 2020 were retrospectively analyzed.Among them,97 patients underwent endoscopic choledocholithotomy combined with laparoscopic cholecystectomy(ERCP+LC)as ERCP group,and 97 patients underwent laparoscopic cholecystectomy combined with choledocholithotomy(LC+LCBDE)as ERCP group The age,gender,intraoperative blood loss,postoperative abdominal drainage tube removal time,ambulation time,postoperative hospital stay,residual stone rate,postoperative complications(postoperative bleeding,biliary fistula,wound infection,pulmonary infection,pancreatitis)and total hospitalization expenses of the two groups were compared.Results1.There was significant difference between LC+LCBDE group and ERCP/EST+LC group in blood loss,conversion to laparotomy rate,drainage tube removing time,food feeding time and hospitalization time(P<0.05).In those aspects,ERCP/EST+LC group was better than LC+LCBDE group.2.In postoperative complications,especially in the probability of occurrence of post-ERCP pancreatitis,LC+LCBDE group was lower than ERCP/EST+LC group(P<0.05).And there was no significant difference in stone retaining rate,postoperative complications(excepting the probability of occurrence of post-ERCP pancreatitis)between two groups(P>0.05).3.ERCP/EST+LC group was significantly higher than LC+LCBDE group in hospitalization cost.ConclusionERCP/EST+LC can shorten the hospitalization time and postoperative activity time effectively.And it was better than LC+LCBDE in reducing blood loss.ERCP/EST+LC has a higher probability of occurrence of post-ERCP pancreatitis,we should be cautious about it.ERCP/EST+LC has a higher cost more than LC+LCBDE,we should choose the appropriate treatment plan according to the patient’s actua condition,we suggest an individual-based treatment.In summary of the above,primary closure after laparoscopic common bile duct exploration could be proposed as the method under appropriate indications.