Retrospective Comparative Study Of Three Endoscopies Combination(Laparoscopic,Choledochoscopy,Duodenoscopy) In The Treatment Of Complicated Extrahepatic Bile Duct Stones

Objective:Retrospective comparative analysis of the clinical value of three endoscopies combination((laparoscopic,choledochoscopy,duodenoscopy)in the treatment of complicated extrahepatic bile duct stones.Methods:From May 2016 to May 2018,a total of 329 patients with extrahepatic bile duct stones were collected from the Department of Hepatobiliary and Pancreatic surgery at Jinan Central Hospital Affiliated to Shandong University.Blood routine,coagulation routine,blood biochemistry and other routine examinations were acomplished after admission.When the age of patients wer more than 60 years old,preoperative examination such as cardiac ultrasound,pulmonary function,color doppler ultrasoud of both lower limbs,bilateral carotid artery ultrasoud and other relevant examinations were required.Combined with the general physical conditions of the patient,to eliminate surgical contraindications.Then,according to abdominal B-ultrasoud,abdominal CT and Magnetic resonance cholangiopancreatography (MRCP)examination,the surgical plan was prepared.Among them,246 patients underwent ERCP,28 patients underwent laparoscopic common bile duct exploration and choledochoscopy for stone extraction and primary suture,30 patients underwent ladparoscopic common bile duct exploration and choledochoscopy for stone extraction and T-tube drainage,25 patients underwent ERCP+ENBD+laparoscopic common bile duct exploration and cholangioscopy and pimary suture,named three endoscopies combination.Laparoscopic cholecyste was performed in all the above gallbladder stones.This article is mainly for large and mulitiple complicted extrahepatic bile duct stones,as well as laparoscopic common bile ductincisioncholedochoscopyforstoneextraction+T-tubedrainageand ERCP+ENBD+laparoscopic common bile duct incision choledechoscopy for stone extraction+pimary suture two different surgical methods.Patients were divided into groups A and B according to the type of surgery they received.In group A,30 cases were treated with ladparoscopic common bile duct exploration and choledochoscopy for stone extraction and T-tube drainage,which was set as the T-tube drainage group.There were 14 males and 16females.In group B,25 cases were treated with ERCP+ENBD+laparoscopic common bile duct exploration and cholangioscopy and pimary suture,which was set as the three endoscopies combined group.There were 12 males and 13 females.There were no satistically significant difference between group A and group B in gender,age,common bile duct diameter,stone number in common bile duct a and ston diameter(P>0.05).The observation indexes were total operation time,total hospital stay,total hospitalization cost,postoperative complications and days with tube drainage in group A and group B.Resluts:Total operation time:T-tube drainage group(group A)(152.43±10.89min)was more than the three endoscopies combined group(group B)(132.04±8.80min).The difference was statistically significant(P<0.05).Total hospital stay:T-bute drainage group(group A)(15.40±4.03day)had longer than the three endoscopies combined group(group B)(10.52±4.03day).The difference was statistically significant(P<0.05).Total hospitalization cost:T-bute drainage group(group A)(21566.63±1873.78yuan)was lower than the three endoscopies combined group(group B)(25326.45±1506.76yuan).The difference was statistically significant(P<0.05).Days with tube drainage:T-tube drainage group(group A)(44.40±3.68day)was longer than the three endoscopies comined group(group B)(6.04±1.17day).The difference was statistically significant(P<0.05).The T-tube group had one case of bile leaking,one of stone residue,one case of Hem-o-lock with ectopic and one case infection of the skin aroud the T-tube.The three endoscopies combined group had no postoperative complications.There was no significant between T-tube drainage group and three edoscopies combined group in the postoperative complications.(?~2=1.89;P=0.109)Conclusion:In the treatment of complicated extrahepatic bile duct stones,the total hospitalization cost of the three endoscopies combined group was higher than that of the T-tube drainage group,but the total number of days in hospital,the total operation time and the days with tube drainage of the three endoscpies combined group were all less than of the T-tube drainage group.The incidence of surgical complications was aslo lower than the T-Tube group.Therefore,the three endoscopies combined treatment for complicted extraheaptic bile duct stones is a relatively safe,feasible and effective treatment method,which is worthy of clinical promotion and apllication.