| Objective:Common bile duct(CBD)stones are common in patients even after cholecystectomy.Besides endoscopic retrograde cholangiography(ERCP),laparoscopic common bile duct exploration(LCBDE)is also applied.This study aims to compare clinical indications,therapeutic benefits and complications for these two managements.Methods:From October 2012 to February 2015,1072 consecutive patients were diagnosed as choledocholithiasis in our single hospital.Post-cholecystectomy patients who underwent ERCP or LCBDE were included.Clinical data were analyzed,such as success rate,complications,procedure duration,postoperative hospital stay,total cost.Prior ERCP,previous biliary anatomic alteration surgeries were the excluding criteria.Results:141 patients were included according to the criteria,and 87 cases underwent ERCP and 54 cases underwent LCBDE.Age and sex distribution of patients were comparable between the two groups.The success rate for CBD stones clearance was 97.7% in the ERCP group,compared with 87.0% in the LCBDE group(p=0.03).The mean procedure duration was also significantly shorter in ERCP group(52.0±15.8 vs.102.9±40.1 min;p<0.001).Postoperative hospital stay was similar(5.5±2.6 vs.5.9±2.3 days;p=0.40).And no significant difference for postoperative complications(3.4% vs.11.1%;p=0.15),total cost(22722.6±6369.0 vs.23901.24±7542.6,p=0.32).Conclusions:For clearing CBD stones in patients after cholecystectomy,ERCP was more efficient and might be the first choice,while LCBDE might be beneficial for patients with large stones.Objective: With the fast development of digestive endoscopy and laparoscope,endoscopic retrograde cholangiopancreatography(ERCP)and laparoscopic common bile duct exploration(LCBDE)have been more and more introduced in the aspect of treating common bile duct stones.ERCP and LCBDE have the advantage of small wounds and last recovery.However,more attention has been paid on the long-term complication of recrudesce of the stones.The aim of this study was to evaluate the risk factors for recurrence after ERCP retrospectively,and provide theory evidence for preventing stone recurrence after minimally invasive treatments in the future.Methods:A retrospective review was performed based on the 602 patients who received ERCP or LCBDE and ensured the common bile duct stones were all removed and the gallbladders were removed in the Jiangsu Province Hospital between October 2012 and August 2016.Telephone follow-up was conducted to collect the clinical data.The clinical data were investigated retrospectively,and risk factors for stone recurrence were univariately and multivariately analyzed.Results:538 patients received the telephone follow-up.64 patients lost to follow-up.The rate of lose follow-up was 10.6%.47 patients undergone stone recurrence,with the rate of 8.7%.The period of follow-up was 9-45 months.The mean period of recurrence was 25.3±8.7 months.Univariate analysis suggested that age,sex,BMI,smoking,drinking,jaundice,high blood pressure,diabetes were of no statistical significance between the two groups.The treatment of stone removal was also of no statistical significance.The diameter of bile duct ?15mm,multi stones,diameter of stone ?10mm were of statistical significance between the two groups.Multivariate analysis identified diameter of bile duct ?15mm,multi stones were the independent risk factors for stone recurrence.Conclusions:For patients who received ERCP or LCBDE treating common bile duct stones and the gallbladders were removed,diameter of bile duct ?15mm(OR=2.758,95%CI:1.421-5.352,P=0.003),multi bile duct stones(OR=2.873,95%CI:1.412-5.703,P=0.005)were the independent risk factors of common bile duct stones recurrence. |
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