The Clinical Analysis Of LC Combined With LCBDE And EST Combined With LC Treatment For Gallstones Combined With Common Bile Duct Stones

Objective: To investigate the efficacy of two methods in the treatment of gallstones combined with common bile duct stones: Laparoscopic cholecystectomy with transcytic common bile duct exploration(LC+LCBDE),and Laparoscopic cholecystectomy after endoscopic sphincterotomy(EST+LC).Methods:A retrospective study about the collection of 110 patients with gallstones combined with common bile duct stones who had surgical treatment during June.2014 to Dec.2015 in Xiamen zhongshan hospital.Separate these patients into group of LC+LCBDE, and group of EST+LC,the LC + LCBDE group according to the line after common bile duct exploration and T tube drainage issue suture is divided into(LC + LCBDE group TD) and(LC + LCBDE group PS), compare the operation time(min)?intraoperation blood loss(ml)?the anus exhaust time(h)?the total hospitalization days(d)?the postoperative complications:intraoperative bleeding?pancreatitis?bowel perforation?bile leakage?calculi residual?bile duct stricture ect.Result: Compare LC+LCBDE with EST+LC,there were no defenrences between general information, age, sex, underlying medical illness,in preoperative parameters between two groups of cases, including common bile duct diameter(mm), number(a), the stones size(mm) and the preoperative level of total bilirubin(umol/L) which have no statistical difference between such information;Time spent in surgical aspect, LC + LCBDE(PS) group less than EST + LC group and LC + LCBDE(TD) group, the difference was significant(P <0.05). The EST + LC group and LC + LCBDE(TD) operative time was quite difference(P> 0.05), no significant difference.In terms of blood loss, LC + LCBDE(PS) group than the EST + LC group than LC + LCBDE(TD) group pairwise comparison significant differences(P<0.05). Which in EST + LC group did not write EST amount of bleeding, so the amount of bleeding in LC-based blood loss.In terms of anal exhaust time, EST + LC group time than LC + LCBDE(PS) group and LC + LCBDE(TD) group time is short,(P <0.05); and LC + LCBDE(PS) group and LC + LCBDE(TD) group time difference insignificant(P> 0.05).In terms of length of hospital stay after surgery, LC + LCBDE(PS) group and EST + LC group considerable time(P <0.05), are better than LC + LCBDE(TD) group, the difference was significant(P <0.05).LC + LCBDE(TD) group 26 cases, short-term complications residual stones and biliary fistula, 2 patients with biliary fistula, through, drainage and natural healing; 2 patients had residual stones, after T-tube cholangioscopy exploration stone preoperative Choledochofiberscope depletion of residual stones; no merger postoperative bleeding, biliary pancreatitis, intestinal bowel perforation. LC + LCBDE(PS) group 28 cases, including biliary fistula in 2 cases, no residual stones were no postoperative bleeding, biliary pancreatitis, intestinal intestinal perforation; EST + LC group of major complications include bleeding, pancreas inflammation, intestinal perforation, which combined pancreatitis in 2 cases, by inhibition of pancreatic secretion, fasting and other symptomatic treatment improved, 3 cases after EST stone residual stones, which in this line EST stone, stone success two cases, one case of stone huge stone fails to be diverted LCBDE stone. 1 cases of postoperative biliary fistula after conservative treatment improved.Residual stone rate LC + LCBDE(PS) group than the LC + LCBDE(TD) group, EST + LC group; EST + LC group than LC + LCBDE(TD) group and LC + LCBDE(PS) group had higher the incidence of pancreatitis, significant differences(P<0.05), the three biliary fistula, postoperative bleeding, intestinal perforation incidence of three categories of non significant difference(P > 0.05).Conclusion:LCBDE+LC is a safe,effective,high feasibility surgercal treatment for gallstones combined with common bile duct stones which has shorter operation time ? less postoperative complications; EST+LC has the advantage of less intraoperation blood loss?faster recovery. Especial suitable for the older and the patients who can't tolerance the surgical strike. Two meathods are both effective in the treat of gallstones combined with common bile duct stones arter strictly grasp surgery pointers.