Effect Of Common Bile Duct Calculi Size On The Choice Of Treatment Strategy Between Laparoscopic Combined Endoscopic And Laparotomy

Objective To group the patients of cholecystolithiasis and choledocholithiasis depend on the maximum diameter of common bile duct calculi,using the EST/EPBD +LC or OC+OCHTD to cure respectively then comparing the curative effect、safety and total cost between the different groups,to explore a better treatment for patients with different size calculi,to provide a reference for clinicians to develop treatment strategies.Method The clinical data of 155 patients which were diagnosed as cholecystolithiasis and choledocholithiasis by abdominal imaging and cured by EST/EPBD+LC or OC+OCHTD from Jan.2010 to Jan 2017 was retrospectively analyzed,divided into 4 groups.Group A:The maximum diameter of common bile duct calculi was between 10 to 20 mm and to treated by EST/EPBD+LC;Group B:The maximum diameter of common bile duct calculi was below 10 mm and to treat by EST/EPBD +LC;Group C:The maximum diameter of common bile duct calculi was between 10 to 20 mm and to treat by OC+OCHTD;Group D:The maximum diameter of common bile duct calculi was below 10 mm and to treat by OC+OCHTD;Group A and B were treated by EST/EPBD several days before LC.Between group A and C、group B and D,there was no significant difference in age、sex ratio、diameter of common bile duct and maximum diameter of common bile duct calculi(P>0.05).To compare the risk of complications and hospital course of group A to C、group B to D by SPSS 24.0.Result Between group A and C whose maximum diameter of common bile duct calculi was between 10 to 20 mm,the total cost of group A was more than group C,but there was no significant difference in terms of removal rate of calculi、the incidence of complications and hospitalization time(P>0.05);Between group B and D whose maximum diameter of common bile duct calculi was below 10 mm,the total cost of group B was more than group D,but there was no significant difference in terms of removal rate of calculi、the incidence of complications and hospitalization time(P>0.05).Conclusion Compare to OC+OCHTD,EST/EPBD+LC is kind of safe and effective treatment for the patients whose maximum diameter of common bile duct calculi was below 10 mm or between 10 to 20mm;EST/EPBD+LC is a minimally invasive treatment causing small trauma,but has no advantage in terms of hospitalization time;When the economic conditions allow,EST/EPBD+LC is kind of recommended therapy for those patients of old age、physical fitness and much underlying disease who are not suitable for open surgery with the maximum diameter of common bile duct calculi below 20 mm.