A Comparative Study Of Laparotomy,Laparoscopy And Laparoscopy Combined With Endoscopy In The Treatment Of Gallstones And Common Bile Duct Stones

Objectives:By campare the clinical efficacy of three surgical methods LC+LCBDE;OC+OCBDE and LC+ERCP+EST on the patients with gallstones and common bile duct stones whose common bile duct diameter is 0.8-1.2cm,to explore the ad-vantages and disadvantages of the three surgical methods for the patients with gallstones and common bile duct stones whose common bile duct diameter is 0.8-1.2cm.Methods:From January 2015 to December 2019,the datas of patients with gallstones and common bile duct stones combining with common bile duct diameter of 0.8-1.2 cm were collected continuously in the Department of Hepatobiliary Surgery,Second Affiliated Hospital of Kunming Medical University,among which 90 cases meeting the inclusion criteria were adopted.These cases were divided into 3 groups(38 cases in LC LCBDE group,23 cases in OC OCBDE group,and 29 cases in LC ERCP EST group).The general datas,The common bile duct diameter,the preoperative leukocyte count,the preoperative neutrophil percentage,the preoperative and postoperative liver function index,the operation time,the intraoperative blood loss,the incidence of postoperative complications,the postoperative biliary drainage time,the postoperative fasting time,the total hospitalization costs,the postoperative hospitalization time and the total hospitalization time were compared statistically.SPSS 22.0 medical statistics software was used for statistical analysis.Results:There were not significant differences in age,gender and common bile duct diameter between the three groups(P>0.05).There were not significant differences between the three groups in preoperative liver function indexes,preoperative leukocyte count and preoperative neutrophil percentage(P>0.05),and the data were comparable.There was not statistical difference in postoperative liver function indexes among the three groups(P>0.05).There was not statistical difference in the operation time between the three groups(P>0.05),and there was a statistical difference in the amount of intraoperative bleeding in the three groups(P<0.01).Further pair comparison showed that the intraoperative blood loss in the LC+ERCP+EST group was significantly less than the LC+LCBDE group and the OC+OCBDE group(P<0.01),and also there was a statistical difference between the LC+LCBDE group and the OC+OCBDE group(P<0.01).The total incidence of postoperative complications in the three groups were:7.9%,8.7%,and 6.9%,there was not statistical difference(P>0.05).There was a statistically significant difference in the postoperative biliary drainage time between the three groups(P<0.01).Further pair comparison showed that the postoperative biliary drainage time of the LC+ERCP+EST group was significantly shorter than the LC+LCBDE group and the OC+OCBDE group(P<0.01).There was not statistical difference between the LC+LCBDE group and the OC+OCBDE group(P>0.05).There was a statistically significant difference in the postoperative fasting time between the three groups(P<0.01).Further pair comparison showed that the postoperative fasting time of the LC+ERCP+EST group was significantly,longer than the LC+LCBDE group and the OC+OCBDE group(P<0.01).There was not statistical difference between the LC+LCBDE group and the OC+OCBDE group(P>0.05).There were statistical differences in the length of postoperative hospitalization time among the three groups(P<0.01).Further pair comparison showed that the postoperative hospital stay in the LC+ERCP+EST group was significantly shorter than the LC+LCBDE group and the OC+OCBDE group(P<0.01).There was not statistical difference between the LC+LCBDE group and the OC+OCBDE group(P>0.05).There were statistical differences in the total hospitalization time of the three groups(P<0.01).Further pair comparison showed that the postoperative hospital stay in the LC+ERCP+EST group was significantly shorter than the LC+LCBDE group and the OC+OCBDE group(P<0.01).There was not statistical difference between the LC+LCBDE group and the OC+OCBDE group(P>0.05).The total hospitalization time of the three groups were statistically different(P<0.01).Further pair comparison showed that total hospitalization time in the LC+ERCP+EST group was significantly shorter than the LC+LCBDE group and the OC+OCBDE group(P<0.01).There was not statistical difference between the LC+LCBDE group and the OC+OCBDE group(P>0.05).Conclusions:For surgical treatment of gallbladder stones and common bile duct stones' patients with common bile duct diameter of 0.8-1.2cm,LC+LCBDE,OC+OCBDE and LC+ERCP+EST are effective,but each type of operation has its own indications and characteristics.In terms of surgical trauma and postoperative recovery,the effect of LC+ERCP+EST is satisfactory.However,there are multiple factors needed to be considered.Therefore,we should take many factors into consideration before we choose appropriate treating method.Only in this way can the most effective and safest choice be made for each patient,in addition,the various surgical methods can maximally play its real role simultaneously.