A Clinical Study On Treatment Of Cholecystolithiasis And Extrahepatic Bile Duct Stones By Laparoscopy Combined With Duodenoscopy

Objective:To comparatively analyze the clinical effect of combination of laparoscopy and duodenoscopy treatment with the traditional laparotomy in clinical management of patients with cholecystolithiasis and extrahepatic biliary stones.Methods:A retrospective clinical data analysis of 89 cases with cholecystolithiasis and extrahepatic bile duct stones from June 2013 to December 2014 was conducted. A total of 45 patients underwent combined treatment with laparoscopy and duodenoscopy (minimally invasive group) and 44 patients underwent the traditional laparotomy (control group). The general clinical data (age, gender, diameter of common bile duct, common bile duct stones, the size of common bile duct stones and multiple common bile duct stones), postoperative anal exhaust time, postoperative analgesic use, postoperative hospitalization time, postoperative complications, hospitalization costs and other clinical parameters were studied and compared between two groups. In minimally invasive group, endoscopic lithotomy was performed firstly. The stones were removed after endoscopic sphincterotomy (EST), stone basket, ordinary stone basket and balloon dilation followed by endoscopic nasobiliary drainage (ENBD). If no postoperative complications occurred such as biliary tract bleeding and pancreatitis, laparoscopic cholecystectomy (LC) was performed 2-3 days after the initial surgery. In the control group, conventional open cholecystectomy, choledocholithotomy followed by T tube drainage were used. The T-tube was removed 4 weeks postoperatively after T tube cholangiography showed no residual stones. SPSS 20.0 for Windows was used for the statistical analysis in this study. The data are presented as means±SEM. Independent t-tests were used to compare the mean for continuous data; Chisquare tests were used for categorical variables. Statistical significance was defined as P< 0.05.Results:There was no statistically significant difference between the minimally invasive group and the traditional laparotomy group in general clinical data including gender, age, diameter of common bile duct, the size of common bile duct stones, or multiple common bile duct stones. The parameters of anal exhaust time, postoperative analgesic use and postoperative hospital stay in the minimally invasive group were lower than those in the laparotomy group. Analysis of this result indicated that the difference was statistically significant. There was no significant difference in the incidence of postoperative complications between two groups. The hospital costs in the minimally invasive group were significantly higher than in the laparotomy group, and the difference was statistically significant.Conclusion:Compared with the traditional laparotomy method, the combination of laparoscopy and duodenoscopy treatment for cholecystolithiasis and extrahepatic bile duct stones had the advantages as followed:less trauma, mild postoperative wound pain, less abdominal organ injuries, little effect on gastrointestinal function, quick recovery, and avoiding the discomfort due to using the T catheter. Despite the higher cost for minimally invasive procedures, with the growing demand from patients for minimally invasive techniques and high quality medical services, the combination of laparoscopy and duodenoscopy treatment has been widely popularized in clinical application.