Comparison Of Single-stage LC+LCBDE And Two-stage ERCP/EST+LC In The Treatment Of Gallstones And Common Bile Duct Stones

BackgroundCholelithiasis is a common and frequently-occurring disease in general surgery,with an incidence of 10%-15%in adults.According to the location of the stones,they can be divided into gallbladder stones and bile duct stones inside and outside the liver.The formation of these stones is related to infectious factors(bacterial,viral,parasitic infections),metabolic factors,dietary factors,genetic factors,etc.,and they work together.result.Gallbladder stones combined with common bile duct stones are mainly treated by surgery.The traditional surgical method is open cholecystectomy+choledocholithotomy+T-tube drainage.However,there are shortcomings such as large trauma,long hospital stay,and many complications,which are gradually being replaced by minimally invasive methods.With the development of laparoscopy technology,there has been a concurrent treatment plan for laparoscopy combined with choledochoscopy and choledocholithotomy.In recent years,with the innovation of endoscopic technology,the use of duodenoscopy for the treatment of common bile duct stones and laparoscopy for the treatment of gallbladder stones have also brought good treatment results for patients.At present,there are two types of minimally invasive surgery for the treatment of gallbladder stones and common bile duct stones.One is laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct exploration(LCBDE),and the other is endoscopic retrograde.Stepwise treatment of pancreaticobiliary angiography(ERCP)/endoscopic sphincterotomy(EST)combined with laparoscopic cholecystectomy.But these two methods have their own advantages and disadvantages,and there is still controversy.ObjectiveThe clinical efficacy of single-stage LC+LCBDE and two-stage ERCP/EST+LC in the treatment of gallstones and common bile duct stones was compared.MethodsA total of 165 patients with gallbladder stones and common bile duct stones who underwent surgery in the First Affiliated Hospital of Zhengzhou University from September 2014 to September 2019 were selected.A total of 84 patients underwent a single-stage laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration as the LC+LCBDE group.A total of 81 patients underwent two-stage endoscopic retrograde cholangiopancreatography/endoscopic nipple sphincterotomy combined with laparoscopic cholecystectomy as the ERCP/EST+LC group.Comparison of intraoperative bleeding volume,operation time,surgical success rate,lithotripsy rate,abdominal drainage tube placement,postoperative recovery time,anal recovery exhaust time,postoperative clinical symptoms,postoperative complications,and surgery Differences in indicators such as post-hospitalization time and total hospitalization cost.ResultsIn the LC+LCBDE group,76 patients had successful surgery,with a success rate of 90.5%,and 6 patients(7.1%)were converted to open common bile duct exploration.In the ERCP/EST+LC group,71 patients had successful surgery,and the success rate was 87.7%.The ERCP/EST+LC group was superior to the LC+LCBDE group in terms of intraoperative blood loss,operation time,number of cases of abdominal drainage tube placement,postoperative recovery activity time,anal recovery exhaust time,and abdominal drainage tube removal time.The LC+LCBDE group was superior to the ERCP/EST+LC group in terms of number of operations,length of hospital stay,total hospitalization cost,and overall patient satisfaction.The differences were statistically significant(P<0.05).There were no significant differences in the success rate of surgery,the rate of conversion to laparotomy,the rate of residual stones,and the total incidence of postoperative complications between the two groups(P>0.05).ConclusionSingle-stage surgery(LC+LCBDE)and two-stage surgery(ERCP/EST+LC)are safe and effective minimally invasive methods for the treatment of gallstones and common bile duct stones.The success rate and the incidence of complications are similar,but the single-stage surgery Treatment is better in terms of shorter hospital stays and cost savings.