| Objectives:To compare the curative effect of OCBDE、LCBDE and EST/EPBD for recurrent choledocholithiasis after biliary tract surgery and the postoperative recurrence and to explore the preventive effect of Qingrelidan granules.Methods:A retrospective analysis about the clinical data 68 cases of hepatobiliary damp heat type recurrent choledocholithiasis after biliary tract surgery who were treated in the first affiliated hospital of Dalian Medical University since January 2013 to September 2016.The patients were divided into three groups by different treatments:13 cases were treated by OCBDE(A group),10 cases were treated by LCBDE(B group)and 45 cases were treated by EST/EPBD(C group).To compare three groups of patients in general conditions,biliary tract,postoperative recovery time of gastrointestinal function,postoperative time of stay in hospital and the types and incidence of complications.We obtained 62 cases of complete data through the telephone and follow-up visit.To compare the probability and time interval of postoperative recurrence in the three groups of patients.To analyze the preventive effect of Qingrelidan granules on postoperative recurrence stones,the patients who took Qingrelidan granules were classified as traditional Chinese medicine group and those who did not take Qingrelidan granules were classified as control group.Results:Among 68 cases of hepatobiliary damp heat type recurrent choledocholithiasis after biliary tract surgery,32 male and 36 female patients,and the average age was 68.88±12.78 years old.The average age of patients in group A was 66.46±12.87 years old,in group B was 60.60±13.31 years old,and in group C was 71.42±11.97 years old.There was statistically significant difference between group C and group B(P<0.05),and the average age of the group C was the largest Comparison of combination of basic diseases and previous biliary tract surgery of three groups was not statistically different(P>0.05).Comparison of combination of periampullary diverticula of three groups was statistically significant difference(P<0.01).The proportion of combination of periampullary diverticula was the highest in group C,and there was statistically significant difference between group A(P<0.01)and statistically different between group B(P<0.05).However,there was no statistical difference of three groups in the maximum diameter of the common bile duct,the maximum diameter and the number of stones(P>0.05).The recovery time of gastrointestinal function in group A was 2.69±0.95 days and in group B was 2.30±1.06 days,and group C did not affect gastrointestinal function.Comparison of recovery time of gastrointestinal function between group A and group B was not statistically different(P>0.05).The postoperative time of stay in hospital in group A was 14.69±6.71 days,in group B was 9.40±2.91 days and in group C was 6.24±2.81 days.Comparison of postoperative time of stay in hospital of three groups was statistically significant difference(P<0.01),and Group A>Group B>Group C.The incidence of perioperative complications in group A was 30.77%,in group B was 10%and in group C was 8.89%.There was no significant difference of three groups(P>0.05).Compared with group C,the incidence of perioperative complications in group A was higher and the difference was statistically significant(P<0.05).A total of 62 patients were obtained with complete follow-up datas.12 cases of them were recurrent and the recurrence rate was about 19.35%.The relapse rate in group A was 16.67%,in group B was 11.11%and in group C was 21.95%.There was no significant difference in the recurrence rate of three groups(P>0.05).The relapse rate of recurrence time distribution in 0.5～1 year in group C was 14.63%,in 1～2 years in group A was 8.33%,group B was 11.11%,group C was 2.44%and in more than 2 years in group A was 8.33%,group C was 4.88%.There was statistically significant difference in the relapse rate of recurrence time distribution of three groups(P<0.05).In the traditional Chinese medicine group,28 patients were treated with Qingrelidan granules,2 cases relapsed and the recurrence rate was 7.14%.In the control group,34 patients were not treated with Qingrelidan granules,10 cases relapsed and the recurrence rate was 29.41%.Compared with the control group,The recurrence rate of the traditional Chinese medicine group was lower than that of the control group(P<0.05).There was no significant difference between the recurrence rate of the traditional Chinese medicine group and of the control group in group A,so was in group B(P>0.05).However,the recurrence rate of the traditional Chinese medicine group was 9.52%and of the control group was 35%in group C,and the difference was statistically significant(P<0.05).Conclusion:Compared with three kinds of treatments for recurrent choledocholithiasis after biliary tract surgery,EST/EPBD had less interference to gastrointestinal function,shorter postoperative time of stay in hospital than OCBDE and LCBDE,because of more minimally invasive.In terms of overall complication rate,EST/EPBD was comparable to LCBDE and significantly lower than OCBDE.But in terms of recurrence rate,there was no significantly difference between three kinds of treatments.However,the stones were easy to relapse after a short period of interval time,which may be related to duodenal papillary sphincter dysfunction in EST/EPBD.Therefore,we tended to choose LCBDE for the younger patients with normal duodenal papillary sphincter function,in order to protect the papillary sphincter.For the patients with abdominal celiac adhesion resulting in that laparoscopic surgery was difficult and large stones that EST/EPBD could not remove,we should choose OCBDE.Qingrelidan granules for hepatobiliary damp heat type recurrent choledocholithiasis after treatment have a satisfactory preventive effect and it is worth being recommended clinically. |
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