Efficacy Analysis Of LCBDE And ERCP/EST In The Treatment Of Common Bile Duct Stones With Stone Diameter >12mm

Objective:To compare laparoscopic common bile duct exploration?LCBDE?with endoscopic retrograde cholangiopancreatography?ERCP?/endoscopic sphincterotomy?EST?for the treatment of choledocholithiasis with a diameter of>12mm,and the advantages and characteristics of the two surgical methods are summarized to provide reference for clinical decision-making.Methods:A retrospective analysis was made on 117 cases of choledocholithiasis with diameter>12mm admitted to the affiliated hospital of Zunyi medical university from January 1,2014 to December 31,2018.they were divided into LCBDE group and ERCP/EST group according to surgical methods,82 cases in LCBDE group and35 cases in ERCP/EST group.The operation time,postoperative hospitalization time,hospitalization expenses,initial stone clearance rate,final stone clearance rate,postoperative short-term complications and postoperative long-term complications of the two groups were compared respectively.Taking the stone diameter of 15mm as the boundary,the cases in LCBDE group were divided into group A:15?stone diameter>12mm,group B:stone diameter>15mm;Cases in ERCP/EST group were divided into group C:15?stone diameter>12mm,group D:stone diameter>15mm.the operation time,postoperative hospitalization time,hospitalization expenses,initial stone clearance rate,final stone clearance rate,postoperative short-term complications and postoperative long-term complications of group a and group b,group c and group d were compared and analyzed,and the clinical efficacy of LCBDE and ERCP/EST in treating common bile duct stones with diameter>15mm was discussed.Qualitative data,expressed as n?%?,were analyzed by chi-square test or Fisher exact probability method.Quantitative data are tested for normality by Shapiro Wilk test,and those satisfying normal distribution are expressed byx±s,and are tested and analyzed by independent sample T test;Those who do not meet the normal distribution are expressed by M(P₂₅,P₇₅),and analyzed by Wilcoxon rank sum test.The difference is statistically significant?P<0.05?.Results:Compared with ERCP/EST group,LCBDE group had longer operation time?197 vs 89 minutes,p<0.001?,longer postoperative hospital stay?7 vs 4 days,p<0.001?,higher initial stone clearance rate?85.4%vs 54.3%,p<0.001?,and higher cholecystectomy rate?78.0%vs 11.4%,p<0.001?in the same period.There was no significant difference in the final stone clearance rate?85.4%vs 77.1%,P=0.279?,hospitalization expenses?31985.25 vs 37500.45,P=0.098?,short-term total complication rate?9.8%vs 17.1%,P=0.260?and long-term total complication rate?5.4%vs 6.1%,p>0.99?between the LCBDE group and ERCP/EST group.Pancreatitis is the major complication after ERCP in 6 cases?17.1%?,and the difference between the two groups is statistically significant?0 vs 17.1%,P=0.001?.Cases in LCBDE group,compared with group B,there was no significant difference in operation time?192.65 vs 206.42 minutes,P=0.333?,postoperative hospitalization time?7.00 vs 7.00 days,P=0.358?,and hospitalization cost?29562.00 vs33478.18 yuan,P=0.425?in group A;Compared with group B,there was no statistical difference in the following indicators in group A,including stone clearance rate?80.4%vs 93.5%,P=0.189?,the rate of cholecystectomy in the same period?78.0%vs 77.4%,P=0.915?,the recent total complication rate?7.8%vs 12.9%,P=0.715?and the long-term total complication rate?6.5%vs 3.6%,P=0.989?.In ERCP/EST group,compared with group D,group C has longer operation time?90.00 vs 78.00,P=0.025?,higher initial stone clearance rate?69.6%vs 25.0%,P=0.015?,and lower biliary stent implantation rate?13.0%vs 50.0%,P=0.038?;Compared with group D,there was no statistical difference in these indexes in group C,which included postoperative hospital stay?4.00 vs 3.00 days,P=0.219?,hospital expenses?38291.65 vs 32706.16,P=0.975?,and final stone clearance rate?78.3%vs 75.0%,p>0.99?;Compared with group D,there was no statistical difference in these indexes in group C,which included the rate of cholecystectomy at the same time?13.0%vs 8.3%,p>0.99?,the recent total complication rate?26.1%vs0,P=0.074?and the long-term recurrence rate of common bile duct stones?4.8%vs8.3%,p>0.99?.Conclusion:?1?LCBDE and ERCP/EST are both safe and effective in the treatment of common bile duct stones with diameter>12mm.LCBDE has higher stone clearance rate in initial operation and has no risk of secondary pancreatitis.Therefore,LCBDE is preferred for patients with stone diameter>12mm who can tolerate operation.?2?ERCP/EST has shorter operation time and shorter postoperative hospital stay,which may be a better choice for patients with choledocholithiasis>12mm in diameter who cannot tolerate long-term operation.?3?For choledocholithiasis with diameter>15mm,the difficulty of taking stones by LCBDE did not increase.However,ERCP/EST significantly increased the difficulty of stone extraction.