Clinical Analysis On Minimally Invasive Treatment For Elderly Patients With Cholecystolithiasis And Choledocholithiasis

Objective : To study the clinical effectiveness of laparoscopic common bile duct exploration(LCBDE)plus laparoscopic cholecystectom(LC)versus endoscopic retrograde cholangiopancreatography(ERCP)/endoscopic sphincterotomy(EST)plus LC in treatment for elderly patients with cholecystolithiasis and choledocholithiasis.Methods:The clinical data of 107 elderly patients(over 60 years of age)with gallbladder and common bile duct stones undergoing minimally invasive therapy in China-Japan Union Hospital from January 2012 to June 2016 were retrospectively analyzed.Of the patients,51 cases received LC plus LCBDE(LC+LCBDE group),including 26 males and 25 females,the average age of(68.27±5.19)years;56 cases had ERCP/EST plus LC(ERCP/EST+LC group),including 32 males and 24 females,the average age of(68.66±5.75)years,and the main clinical variables between the two groups of patients were compared.Results:In LC+LCBDE group versus ERCP/EST+LC group,the surgical success rate [92.2%(47/51)vs 91.1%(51/56),P=0.840] and incidence of postoperative complications[9.8%(5/51)vs 10.7%(6/56),P=0.877 ] showed no significant difference,but the hospitalization cost was significantly decreased [(37497±9314)yuan vs(47709±10552)yuan,P<0.001 ]and the length of hospital stay was significantly shortened [(11.31±3.432)d vs(13.27±3.600)d,P=0.005].A total of 89 patients from both groups were followed up for 6 to 60 months,and the incidence of stone recurrence,pancreatitis and biliary tract infections showed no significant difference between the two groups of patients,and no biliary stricture and malignant transformation of the bile ducts occurred in either group of patients.Conclusion: Both LC + LCBDE and ERCP + LC are safe and effective For elderly patients with concomitant cholelithiasis and choledocholithiasis.LC+LCBDE approach has obvious advantages in reducing hospitalization cost and length,and it has no limit to the number and size of the choledocholithiasis,further it can preserve the function of the sphincter of Oddi.So,it should be considered as the first choice of option in most elderly patients.However,based on the individualization principle,procedure should be selected flexibly according to the patients’ and technical conditions.