Clinical Study Of Complex Calculus Of Common Bile Duct Stones ERCP Staging Treatment

Objective: To investigate the efficacy, safety and feasibility of complexcalculus of common bile duct stones ERCP staging treatment.Methods:First, we chose40cases of bile-duct-stone patients with failedcomplicated endoscopic lithotomy from August2010to August2012assamples, and placed a plastic biliary stent under the endoscopy. After3months/6months, we review color Doppler ultrasound, and observe thechanges of bile duct stones, then perform another endoscopic stone extractionaccording to the current state.Then compare the quantity changes of whiteblood cell(WBC), alanine aminotransferase (ALT), aspartate aminotransferase(AST), total bilirubin(T-Bil), direct bilirubin(D-Bil)before and after theoperation to illustrate the effect that how the placement of biliary stent canpalliate the biliary obstruction, and the effect on the control of infection ofbiliary tract. We also should pay attention to whether there is anyhyperamylasemia, acute pancreatitis bleeding, perforation or othercomplications after the operation. during in the follow-up, observation ofwhether there is blocking bracket, shedding, intestinal perforation or othercomplications should be focus on. If the patients have abdominal pain, fever,skin or mucosa stained yellow, they should return take a review without delay.Results: The40patients were successfully placed biliary stent, amongwhich the single stent (group S)take up19cases, and double stents (group D)take up21cases.3months after the surgery,29cases take all the calculi byERCP, including13cases of S group and16cases of D group;6months afterthe operation, a total of37(92.5%)cases take all the calculi by the second timeERCP, including17cases of S group and20cases of D group.6months afterthe operation, there is no statistical significance between the two groups (P =0.489) on the stone clearance rate.3months after operation,40patients withbile duct stone show different degrees of reduction of the diameter (mm). Onthe stone diameter reduction, it is statistically significant(p=0.044)comparedthe double stent group (6.95±2.33mm) with the single stent group(5.42±2.32mm); there are3cases that calculi didn’t reduce obviously,including the2cases in (group S), and1case in(group D), so we need a longtime follow-up. During the6months’ follow-up, there are9cases (7cases in Sgroup, and2case in D group) appeared abdominal pain, fever, skin andmucosa sclera jaundice or cholangitis clinical manifestations, all of whichcaused by stent obstruction, and the symptoms disappeared after a stentreplacement. There is no stent loss nor severe complications such as intestinalperforation. As to long-term complications(stent blockage), there is statisticalsignificance between the double stent group and single stent group (X2=2.079P=0.039). In the group of40patients, the levels of preoperative white bloodcell count(WBC X109/L), alanine aminotransferase (ALT U/L), aspartateaminotransferase(AST U/L), total bilirubin (TBIL umol/L), direct bilirubin(DBILumol/L) were (11.54±4.81),(116.63±86.74),(100.78±69.31),(67.75±67.43),(49.43±54.26); after1days and3days after operation,respectively (8.78±2.89),(84.65±55.90),(63.58±43.37),(49.30±50.11),(32.31±36.01) and (6.5±2.10),(38.20±25.59),(29.90±20.84),(49.30±50.11),(12.41±14.87);Among them, comparing the white blood cell count declinationpreoperatively and postoperatively1days(t=3.103、 P=0.003) andpostoperatively3days(t=5.980、 P＜0.01) was statistically significant,comparing alanine aminotransferase, aspartate aminotransferase, totalbilirubin, direct bilirubin’s decreation preoperatively and postoperatively1days was not significant (P=0.054, P=0.061, P=0.169, P=0.101),preoperatively and postoperatively3days had a statistical significance(P<0.01, P <0.01, P<0.01, P<0.01). Totally,3cases got intraoperative bleeding,5cases got postoperative hyperamylasemia (blood amylase≥3times asnormal),3cases got acute pancreatitis, and they were relieved by symptomatictreatment. Within1week abdominal pain, jaundice was relieved; there is no significance between single stent group and double stent group in recentcomplications.Conclusion: It is a safe, effective, and feasible method to treatcomplicated bile duct stones by stent implantation stage treatment, especiallyfor the elderly patients with high risk. There is no difference betweentreatment by single support and double bracket on early complications. But forthe long-term complications; single support is more easily blocked. In addition,double stent is superior to single support on diminishing the stent stone’sdiameter.