| [Background]Cholelithiasis has become one of common diseases in general surgery department, which includes lithiasis in gall bladder and bile duct. The typical clinical presentation is called Charcot triad, which performs abdominal pain, chill, high fever and jaundice. Some patients can also have no clinical presentation. Laparoscopic technology has been used widely even in primary hospitals to treat many kinds of general surgical diseases since the theory of minimally invasive surgery was proposed. So has it in operative treatment of choledocholithiasis. Recently the usual surgical methods of cholecystolithiasis and choledocholithiasis are LC+LCBDE which is a kind of "one-stage" surgery and ERCP+EST+LC which is a kind of "two-stage" surgery. In the development of combined application of laparoscopic and choledochoscope technique, LC+LCBDE was the widely recognized therapy method. Lately, ERCP+EST+LC was widely used to reduce surgical trauma. But choledocholithiasis found in LC is another question that ERCP+EST+LC can not solve perfectly. So surgeons began to look for another "one-stage" therapy method to solve the question. They made it until a medical centre in California reported 16 successful cases of LC+LTCBDE.[Objective]The objective of this applied research is to study the security, effectiveness, advantage and boundedness of LTCBDE by analyzing the background information and the operation related index and reviewing the related literatures. It can also help surgeons to choose the most appropriate therapy method for high surgery effectiveness and low risk of complications.[Methods]Study the security, effectiveness, advantage and boundedness of LTCBDE by retrospective analyzing the background information,which includes sex, age, weight, course of disease, diameter of common bile duct and ductus cysticus etc, and the operation related index, which includes operation time, blood loss,postoperative hospital stay, and postoperative complications, etc of the 25 patients with cholecystolithiasis and choledocholithiasis of LC+LTCBDE,30 of LC+LCBDE and 25 of ERCP+EST+LC from July 2011 to February 2016 and compare them.[Results]Background information:The diameter of common bile duct (15±8mm> 10±2mm&12±4mm) and stones (15±10mm>5±7mm&8±7mm) of LCBDEis obviously bigger than the other two groups. The diameter of ductus cysticus of LTCBDE is obviously bigger than the other two groups (8±5mm>5±2.25mm & 5±0mm). There are also obvious differences in stone nature and the use of biliary balloon dilator and laparoscop. But there is no obvious difference in sex, weight, course of disease and stones quantity.The operation related index:The medical cost of LTCBDE is obviously lower than the other two groups (17764±10036yuan< 23929±10079yuan & 40829±14861yuan). The peritoneal drainage duration (8±1.5d> 0±4.5d & 0±3d) volume of peritoneal drainage (101±96.25ml>0±55ml&0±20.5ml), postoperative hospital stay (9±2.25d>5±4d&4±4) and the rate of postoperative fever (70%> 48% &24%) of LCBDE are obviously higher than the other two groups. The blood loss of LCBDE is more than ERCP (20±30ml>10±15ml). The operation time of ERCP is shorter than the other two groups (70±55min<120±32.5min&130±62.5min)[Conclusions]1. The effectiveness of LTCBDE, LCBDE and ERCP+EST is satisfying.2. The advantages of LTCBDE is shorter postoperative hospital stay, less peritoneal drainage, lower medical cost and decrease of T tube-related complications.3. The boundedness of LTCBDE is higher requirement of medical condition and skill level, condition of extrahepatic bile duct, location of stones, diameter of stones and quantity of stones. |
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