| Objective: This group of research is to explore the efficacy,safety and feasibility of ERBD combined with LCBDE in the treatment of moderate and severe acute cholangitis,explain the clinical application value of the treatment plan.Method:1.In this retrospective cohort study,128 cases of acute cholangitis with common bile duct stones admitted to the Second People’s Hospital of Wuhu City from January 2020 to June 2021 were collected,and they were divided into three groups according to different treatment options.Group A chose 25 cases of biliary drainage through ERBD,and LCBDE after ERBD drainage in the second stage;Group B chose58 cases of ERCP treatment,conditions allow simultaneous stone extraction(EST,EPBD,net basket stone extraction,etc.)+ ENBD,condition In severe cases,ENBD was performed directly,and nasal cholangiocarcinography was performed after the disease was stabilized.If there are residual stones,the second-stage ERCP stone removal was performed;2 cases failed to place the nasobiliary duct and selected surgery,and 4 cases did not have ERCP stone removed after ENBD and selected surgery;group C 45 patients underwent LCBDE or OCBDE treatment after conservative treatment,of which5 cases were exacerbated and had emergency biliary drainage,2 cases received ERCP treatment,and 3 cases received surgical treatment.Summarize the general information of the three groups of patients,the total length of hospitalization,the cost of hospitalization,the rate of one-time stone removal,and the total incidence of complications for analysis.2.25 and 38 patients with moderate and severe acute cholangitis in groups A and B were screened,and 6 patients in group B who had failed to remove ENBD and ENBD were selected for surgical treatment.25 and 32 patients were screened out as group A1 and group B1.The changes in liver function and infectivity indexes of patients before and 3days after biliary drainage were compared by themselves;the visual analogue scale(VAS)in pain assessment was used to evaluate the two groups at different periods(before ERCP,24 h after operation,and after operation).3 days,1 week after surgery)the feeling of discomfort.The differences in total hospitalization time(days),total hospitalization expenses(million),one-time stone retrieval rate,stone retrieval success rate,total complication rate,and stone recurrence rate between the A1 and B1 groups were compared and analyzed.The curative effect and scope of application of ERBD combined with LCBDE in the treatment of moderate and severe acute cholangitis are described.3.According to the size and number of common bile duct stones,A1 and B1 are further grouped.Respectively: stones ≤ 2 and diameter <15mm,stones ≥ 3 or diameter ≥15mm.Then compare the treatment effects of the A1 and B1 groups respectively.The curative effect and scope of application of ERBD combined with LCBDE in the treatment of moderate and severe acute cholangitis are described.Result: 1.There is no significant difference in age and sex ratio between groups A,B and C(P>0.05).According to the TG18 severity classification,the proportion of mild in group C was 82.22%,which was higher than that of groups A and B,the proportion of moderate was lower than that of groups A and B,and the proportion of severe was lower than that of group A,with statistical difference(P<0.05);There was a statistically significant difference between group A and group B in the proportion of mild to moderate(P<0.05);the combination of C combined with basic medical diseases(Hypertension,diabetes,coronary heart disease,COPD,cerebral infarction)accounted for 20.00%,which was lower than that of group A and group B,with statistical difference(P<0.05);three There were statistical differences between the groups in the history of biliary surgery,the number of stones,the diameter of the common bile duct,the length of hospitalization,the cost of hospitalization,and the total complication rate(P<0.05).There was no significant difference in the one-time stone clearance rate between the three groups(P>0.05).There was no significant difference in the total complication rate between group A and group C(P>0.05).There was no significant difference in the number of days of hospitalization and total hospitalization expenses between group B and group C(P>0.05).2.The general clinical data of the two groups of patients A1 and B1 are basically the same in age,gender,severity,medical comorbidities,stone characteristics,common bile duct diameter,biliary surgery history,laboratory examinations(systemic inflammatory indexes,liver function indexes).The difference is not significant(P>0.05),and it is comparable.After ERBD and ENBD drainage in the A1 and B1 groups,the systemic inflammatory indexes(WBC,CPR,PCT)and liver function indexes(TBIL、DBIL、ALP、AST、ALT、γ-GTP)and their own surgery 3 days after surgery In the previous comparison,the two groups were significantly decreased(P<0.05);the visual analogue pain score(VAS score)of the A1 group was lower than that of the B1 group 3 days after the operation and one week after the operation,and there was a statistical difference(P<0.05);3.The hospitalization time in groups A1 and B1 was 14.78±4.56 days,12.12±2.56 days,P=0.0073;hospitalization expenses were 2.36±0.14 million,2.38±0.22 million,P=0.6938;the rate of one-time stone exhaustion was 96.0%(24/25),68.75%(22/32),P=0.0245;the total complication rate was 12.0%(3/25),34.375%(11/32),P=0.0208;the success rate of stone retrieval was 100%,respectively(25/25),90.625%(29/32),P=0.3295.4.When the common bile duct stones in the A1 and B1 groups were ≤2 and the diameter was less than 15 mm,the general data of the two groups were basically the same(P>0.05);the hospitalization time of the B1 group was 7.59±1.78 days lower than that of the A1 group 12.78±1.13 days.(P=0.0000);the average hospitalization cost is1.28±0.13 million yuan,which is lower than 2.12±0.2700 yuan in group A1,(P=0.0000).There was no significant difference in the rate of one-time stone removal,the success rate of stone removal,and the total complication rate in groups A1 and B1(P>0.05).When screening for common bile duct stones ≥3 or diameter ≥15mm,the general data of the two groups were basically the same(P>0.05);the one-time stone removal rate of group A1 was 94.737%(18/19)was significantly higher than that of group B1 40.00%(6/15),(P=0.0000);the complication rate of 10.526%(2/19)was significantly lower than that of the B1 group 53.333%(8/15)(P=0.0100).There was no statistically significant difference in the success rate of stone retrieval,average length of hospital stay,and hospitalization expenses(P>0.05);5.In the A1 group,the interval between the second phase of LCBDE was 14-109 days,with an average of(39.00±22.12)days.There was no conversion to laparotomy.The intraoperative blood loss was 10-100 ml,with an average of(50.25±2.53)ml,and the operation time ranged from 45-150 minutes,with an average of(70.08±22.62)minutes.Postoperative bile leakage occurred in one patient after the operation,and 150-400 ml bile volume was drawn out every day after the operation.No special intervention measures were taken to keep the bile drainage smooth and healed.T-tube intubation time was 24-38 days,with an average of(28.9±3.56)days;T-tube angiography was performed,and 1 case(4.00%)had residual stones,and the stones were removed by T-tube sinus choledochoscope.6.The current follow-up time is 2-12 months,and there is no recurrence of stones in the three groups.Conclusion:1.ERBD can effectively control moderate and severe acute cholangitis,and can also reduce the early complications of ERCP.The cause of obstruction needs to be treated in the second stage.Early biliary drainage can be given priority to ERBD;2.In patients with common bile duct stones with moderate or severe acute cholangitis,when the diameter of the stones is ≥15 mm or the number is ≥3,the second-stage LCBDE has a higher stone clearance rate,which can effectively protect the function of Oddi’s sphincter and reduce complications happen. |
