Clinical Indications Of Three Treatments For Choledocholithiasis With Acute Cholangitis

Objective: This study aimed to compare the curative effect of three methods and to provide some references for treatment of choledocholithiasis with acute cholangitis,by analyzing the therapeutic advantage and deficiency of Endoscopic retrograde cholangiopancreatography(ERCP),commom bile duct exploration and Percutaneous Transhepatic Cholangiography combine commom bile duct exploration in treatment of choledocholithiasis with acute cholangitis.Methods: 283 inpatients with choledocholithiasis with acute cholangitis in the affiliated hospital were retrospectively evaluated,from January 2010 to December 2018.According to the different treatment methods,inpatients were divided into three groups:Group A(ERCP group),Group B(commom bile duct exploration group)and Group C(PTCD combine commom bile duct exploration group).Compare the three group of inpatients in general situation to test their comparability.Then,compare in the hepatic function recovery,inflammation level control,blood loss,postoperative hospital stay and postoperative complication among three groups.Results: Preoperative general information: No significant differences showed in gender,age,combined with medical diseases,diameter of common bile duct,preoperative liver function and WBC level among three groups.There were statistical differences in the number and diameter of stones,and group A(ERCP group)had fewer stones and smaller stone diameter than other two groups.The levels of ALT,AST,GGT,TBIL and WBC in 3days after treatment were significantly decreased among three groups.Group A has the least blood loss,which showed significant difference comparing other groups.The incidence of pancreatitis in group A was significantly higher than that in other two groups.For the days of hospitalization,group A was significantly less than group B and group C,group C was significantly less than group B.Conclusion:1.For patients with choledocholithiasis less than 2,stone diameter less than 15 mm and mild symptoms,ERCP+EST+ENBD is recommended.2.For patients with more common bile duct stones,larger diameter,stable condition and mild inflammation,common bile duct exploration is recommended.For patients with severe condition,rapid development and severe inflammation,PTCD combine common bile duct exploration is recommended.