Analysis Of The Therapeutic Effect Of Laparoscopic And Endoscopic Treatment Of Choledocholithiasis After Cholecystectomy

Objective:To compare the clinical efficacy of laparoscopic choledochal exploration and endoscopic retrograde cholangiopancreatography for patients with post-cholecystectomy Methods:Patients with choledocholithiasis with previous history of cholecystectomy admitted to our hospital from January 2012 to January 2019 were selected as the study subjects,and according to the different treatment methods,they were divided into LCBDE group(49 cases)and ERCP group(76 cases).The surgical success rate,stone residual rate,postoperative hospitalization time,hospitalization cost,postoperative complications and stone recurrence were retrospectively analyzed and compared between the two groups Results:The two groups of patients are comparable in terms of gender,age,method of cholecystectomy,length of resection,diameter of common bile duct before surgery,number of stones(P >0.05).The operation success rate of A group was 95.9%,and that of the B group was 92.1%.There was no significant difference in the operation success rate between the two groups(p>0.05).In group A,2 cases of stone removal failed,all due to severe abdominal adhesions,then switched to OCBDE。There were 5cases in group B that failed to remove stones,of which 4 cases were due to excessively large stones,1 case due to stenosis of the lower part of the common bile duct.Two patients with hard stones were taken out of the stones after the second ERCP,and the other two cases were transferred to surgery for stone removal.1 case of lower bile duct stenosis was transferred to surgery.Group A has higher hospital costs(3.56±0.79 vs 1.49±0.59,p=0.00)and longer postoperative hospital stay(7.33±3.16 vs 4.66±2.04 d,p=0.00).The postoperative complication rate in group A was 6.1% and that in group B was 11.8%.There was no significant difference in postoperative complications between the two groups(p>0.05).In group A,there were2 cases of biliary fistula and 1 case of intestinal obstruction,all of which were cured after conservative treatment;in group B,6 cases of acute pancreatitis,2 cases of acute cholangitis,and 1 case of hemorrhage occurred after operation.By the follow-up deadline,the follow-up time of group A was 4.25±1.45 years,and the follow-up time of group B was 4.9±1.58 years.There was no statistically significant difference between the two group(p>0.05).There were no residual stones in group A,but 3cases(3.9%)in group B.The difference was not statistically significant(p>0.05).There was 1 case(2.0%)recurrence of stones in group A,and 10 cases(13.2%)of stones recurrence in group B.The difference was statistically significant(p=0.032).There were no deaths in the two groups.Conclusion:For patients with choledocholithiasis after cholecystectomy,both LCBDE and ERCP can achieve satisfactory results.LCBDE has lower recurrence rate of stone,while ERCP has advantages of less trauma and faster recovery.