The Comparison Of Clinical Curative Effect, The Cost Of Quality Analysis And Survival Of LCBDE And OCBDE In The Treatment Of Common Bile Duct Stones

Objective:This study aims to discuss and analysis the feasibility of LCBDE and OCBDE cost analysis and the evaluation of the patients quality of life..Methods:Strict into and out of the standard, Choose in June2012to October2013in the second affiliated hospital of kunming medical university had liver hospitalization,confirmed by B ultrasonic CT or MRI (MRCP) in84patients with common bile duct calculi, males in36cases (42.9%), males in48cases (57.1%), sex ratio1:1.33, aged from42to67, the average age was55.4±13.1.58cases gall bladder calculi complicated with bile duct calculi,26case simple bravery managers.40cases single bravery manager stone and44cases of multiple stones. Preoperative have abdominal pain Fever or history of jaundice. Preoperative ultrasound common bile duct diameter of11.6～22.4mm, stone diameter of4.7～17.8mm.22cases of hypertension disease, myocardial ischemia in8patients,58cases of diabetes, mild abnormal liver function in13cases. Randomized divided the cases into two groups, respectively treated by LCBDE or OCBDE.Result:(1)Two groups obtained higher CBDS removal rate and the success rate of operation, there was no significant difference (P>0.05); and there was no significant difference of total bilirubin and serum3days in two groups after ALT (P>0.05); the operation time in LCBDE group was higher than that in OCBDE group, the difference was statistically significant (P<0.05); however, the amount of bleeding and the length of incision of LCBDE was lower than that in OCBDE group, the difference was statistically significant (P<0.05).(2) In LCBDE group, hospitalization time, gastrointestinal function recovery time, bed time, recovery from daily work, and life time were lower than those of OCBDE group, the difference was statistically significant (P<0.05); T tube removal time was higher than that of group OCBDE (P<0.05).(3) In LCBDE group, operation and treatment cost was higher than that in the OCBDE group, the difference was statistically significant (P<0.05), but the indirect cost was lower than that in OCBDE group, the difference was statistically significant (P<0.05); the total cost of LCBDE group was higher than that in OCBDE group, the difference was statistically significant (P<0.05).(4) In LCBDE group, there were4cases with complications (9.52%), while10cases in OCBDE group (23.81%), the rate of LCBDE group was lower than that in the OCBDE group, the difference was statistically significant (P<0.05); in LCBDE group,1cases with incision infection/liquefaction (2.38%), while4cases in OCBDE group (9.52%), there was a significant difference between the two groups (P<0.05);0cases of peritoneal infection in LCBDE group (0%), while3cases in OCBDE group (7.14%), the difference was statistically significant (P<0.05).(5)1cases had postoperative pain in LCBDE group (2.38%), and4cases in OCBDE group (9.52%) there was statistically significant difference (P<0.05); LCBDE group had1cases of gastrointestinal reaction (2.38%), and3cases in OCBDE group (7.14%) there was statistically significant difference (P<0.05).(6) Before operation, the difference of GIQLI source between the two groups was not statistically significant (P>0.05); after operation, two groups were quality of life satisfaction, the score of GIQLI was significantly increased (P<0.05); the two aspects of subjective symptoms, special disease status scores in LCBDE group were higher than the OCBDE group, the difference was statistically significant (P<0.05).Conclusion:(1) Scavenging rate and success rate of two kinds of treatment CBDS was familiar, but there were difference in the operation process between them, LCBDE group has rapider recovery and lower postoperative pain or gastrointestinal adverse reaction probability than OCBDE group.(2) Compared with OCBDE, LCBDE operation had the advantage of less traumas, patients spend a shorter hospital stay, could obviously reduce the medical burden.(3) The result of GIQLI analysis for two methods showed that both methods achieved satisfactory therapeutic effect, but the LCBDE effect was better, its scores in patients with symptoms and disease state were higher.