| Objective:To compare and analyze the clinical efficacy of laparoscopic choledochoscopy combined with choledochoscopy(combined with binoscopy)in the treatment of recurrent choledocholithiasis(CBDS)with ERCP/EST.Methods:Retrospective analysis was performed on 184 cases of recurrent choledocholith-iasis after biliary tract operation admitted to jiangxi provincial people's hospital from January 2015 to January 2020.According to the different operation methods,the patients were divided into two groups: group a and group b.42 patients in group a underwent double-mirror combined biliary tract exploration for stone extraction,and64 patients in group b underwent ERCP/EST for stone extraction.The differences in surgical success rate,calculus clearance rate,postoperative hospitalization day,hospitalization expenses,and surgical complications between the two groups were compared and analyzed.Results:There was no statistically significant difference between the two groups in age,gender,bile duct diameter,combined medical diseases,preoperative white blood cell count(WBC),and preoperative liver function index(ALB/TBIL/ALT)(P >,0.05).In group a,2 patients switched to laparotomy,with a success rate of 95.2%;in group b,6patients failed to perform ERCP/EST stone extraction.Among them,2 patients changed to LCBDE due to too large calculi,and 4 patients underwent ERCP/EST stone extraction again several days after the failure of nipple intubation,with a success rate of 90.6%.There was no statistically significant difference in the success rate between the two groups(P = 0.38).One patient in group a had postoperative stone residue,and 3 months later,percutaneous t-tube sinus duct choledochotomy was performed,and the stone clearance rate was 97.6%.5 patients in group b hadpostoperative stone residue.ERCP/EST was performed again,and the stone clearance rate was 92.2%.The postoperative length of stay was(8.6±3.2)and(6.0±2.8)days,respectively,with statistically significant differences(P < 0.001).The hospitalization expenses of group a and group b were RMB(35898.6±9747.9)and RMB(20304.4±3489.7),respectively.The difference between the two groups was statistically significant(P < 0.001).First six cases of perioperative complications,including bile leakage,abdominal bleeding,infection of incision,abdominal infection in 1 case,all recovered after conservative treatment,intraoperative duodenal injury in 2 cases,be in laparoscopic repair,8 cases of complications b,including abdominal infection in 1 case,nipple hemorrhage in 2cases,1 biliary infection,3 cases of postoperative acute pancreatitis were recovered by the internal medicine conservative treatment,the duodenum injury in 1 case after the surgery,laparoscopic repair success,a,b two groups there was no statistically significant difference of overall complication after surgery(P = 0.79),but the incidence of postoperative acute pancreatitis higher b,The difference between the two groups was statistically significant(P = 0.03).The average follow-up time was(26.7±18.4)months in group a and(32.3±18.3)months in group b,respectively,with a follow-up rate of 85.7% in group a and 84.4% in group b.There were 2 cases of postoperative stone recurrence in group a,with a recurrence rate of 5.6%,and 12 cases of postoperative stone recurrence in group b,with a recurrence rate of 22.2%.There was a statistical difference in the recurrence rate between group a and group b(P = 0.03).Conclusion:1.For the patients with recurrent choledocholithiasis after biliary surgery,the short-term efficacy of double-oscopy combined with choledocholithiasis exploration and ERCP/EST lithotomy are both safe and reliable,with accurate efficacy.2.Although the length of hospitalization and the cost of hospitalization are relatively high,ERCP/EST lithotomy results in the permanent loss of Oddi's sphincter function,which will increase the risk of postoperative acute pancreatitis,recurrent biliary tract infection and other short-term and long-term complications.3.Preoperative comprehensive consideration should be given to the patient's age,physical condition,stone site,size and number,as well as the combination of intrahepatic bile duct stones and other various factors. |
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