Treatment Choice For Common Bile Duct Stone In Era Of Minimally Invasive Surgery

Objective To compare the clinical effect and total expense of laparoscopic cholecystectomy combined with common bile duct exploration (LC+LCBDE) and endoscopic sphincterectomy prior to laparoscopic cholecystectomy (LC+EST) for common bile duct stone and to evaluate the feasible and economical and minimally invasive methods for gallbladder stone and common bile duct stone.Methods The clinical data of 92 cases of patients with gallbladder stone and choledocholithiasis were analyzed from May 2008 to May 2010, including 30 cases of LC+LCBDE and 62 cases of LC+EST,among the 92 cases,preoperative status ,surgical success rate ,operative time,intraoperative blood loss,the serum levels of alanine aminotransferase(ALT) and total bilirubin(TBIL) at 3th day after operation,hospital stay,short-term complications and total expense were recorded.Results The EST group presented less intraoperative blood loss [(45.35±15.8vs (110.55±30),P<0.05), shorter hospital stay [(8.6±2)d vs (14±4)d,P <0.05=,but higher cost in hospital [(16342±1803) VS(20960±2150)元,P<0.05],1 case of LCBDE group conversed to an open surgery because of difficulty in lithotomy,4 cases of EST group conversed to LCBDE because of big stone and duodenal papil variation respectively,1 case of LCBDE appeared peritonitis after removing the T-tube;2 cases in LC+EST group experienced transient high serum, and 2 cases in LCBDE suffered from little bile leak ,all cases were followed up for 8～16 months with a median 12 months,in EST group,bile duct recurrent stones were seen in 2 cases(3.2%),cholangitis in 3 cases(4.8%);in LCBDE group bile duct recurrent stones were seen in 1 cases(3.3%). There was no significant difference in preoperative status ,surgical achievement ratio ,short-term complications(P >0.05).Conclusion EST group has shorter postoperative hospitalization but more hospital cost compared to LCBDE group .Both LC+LCBDE and EST+ LC are safe and reliable , the optimal procedures should be selected according to the practical conditions of the hospital.