The Analysis Of The Risk Factors Of Common Bile Duct Stones And The Clinical Study Of The Three Operation Methods

Objectives Choledocholithiasis is a common disease of biliary tract system in China.Its incidence is increasing year by year.At present,there are few related studies on choledocholithiasis in Tibetan population.This paper provides a basis for clinical work through the analysis of Tibetan choledocholithiasis.1.To analyze the risk factors of common bile duct stones in Tibetan.These data were provided for prevention of common bile duct stones in Tibetan population.2.To compare the clinical efficacy and cost-effectiveness of traditional laparotomy,endoscopic retrograde cholangiopancreatography(ERCP)and laparoscopy combined with choledochoscopy in the treatment of common bile duct stones.Methods 1.We collected the clinical data of 195 cases of Tibetan common bile duct stones patients treated in the Tibet Autonomous Region People's Hospital between November 2016 and November 2017,and compared with 195 cases of Tibetan fracture patients.Risk factors for the formation of common bile duct stones were analysed.2.A retrospective analysis included 244 cases of Tibetan patients with common bile duct stones in the Tibet Autonomous Region People's Hospital from May 2015 to November 2017.According to the surgical methods,all patients were divided into three groups: surgery group,ERCP group and laparoscopic group.The stone removal rate,the largest diameter of stones,the amount of intraoperative blood loss,operation time,intraoperative and postoperative complications,staying time in hospital,hospital days after surgery and the hospitalization costs were compared among the three groups.Results 1.There was an effect on the formation of common bile duct stones in terms of gender,living altitude,smoking,drinking,cholecystectomy,hyperlipidemia and hypothyroidism.Patients with common bile duct stones are more common at altitudes of 3000–3999 meters.Multivariate logistic regression analysis showed that female(OR=3.522(2.045–6.068)),drinking(OR=4.190(1.922– 9.136)),history of cholecystectomy(OR=6.316(3.061–13.031)),hyperlipidemia(OR=5.625(2.589–12.221))and hypothyroidism(OR= 3.034(0.973–9.456))are related to the formation of choledocholithiasis.2.The stone removal rate,the largest diameter of stones and the incidence of intraoperative and postoperative complications had no significant difference in the three groups.The amount of intraoperative blood loss is(17.80±5.44)ml in ERCP group,which was less than the other two groups(P < 0.05).The average hospitalization time was(12.00(8.00,19.50))days and the hospital days after surgery was(7.00(4.00,9.50))days in ERCP group,which were shorter than the other two groups(P < 0.05).The hospitalization costs was(27123.95(21975.56,34656.81))yuan in ERCP group,which was cheaper than the other two groups(P<0.05).The operation time was(73.69±14.99)minutes in ERCP group,which was less than the other two groups(P<0.05).Conclusion 1.Female,drinking,cholecystectomy,hyperlipidemia and hypothyroidism were related with the formation of common bile stones.Tibetans should develop good eating habits and healthy lifestyle to prevent the occurrence of common bile duct stones.2.ERCP is more effective than traditional open surgery and laparoscopic surgery in the treatment of common bile duct stones,with shorter recovery time and lower hospitalization costs.