Comparison Of Clinical Efficacy Between ERCP And CBDE For Choledocholithiasis With Acute Cholangitis In Elderly Patients

Objective: To investigate the effect of ERCP and CBDS in the treatment of elderly patients with choledocholithiasis and acute cholangitis.Methods:A retrospective analysis was conducted on 200 elderly patients(over 65 years old)with choledocholithiasis complicated with acute cholangitis admitted to the general surgery department of Guangzhou Red Cross hospital hospital from January2009 to January 2019,which were divided into ERCP group(110 cases)and CBDE group(90 cases)according to different surgical methods.Statistics in patients with the clinical data and preoperative laboratory,ASA rating,surgery,postoperative recovery(postoperative feeding time,postoperative gastrointestinal function recovery time,net rate of stone,the third day after laboratory index),hospitalization time,length of hospital stay,postoperative hospital stay,postoperative ICU hospitalization cost,postoperative complications and follow-up found stone recurrence.SPSS 25.0software was used to analyze the data of this study.Results:1.ERCP and CBDE group two groups of patients in the general clinical data(gender,age),the number of common bile duct calculi(single,multiple),common bile duct diameter,ASA rating,preoperative laboratory tests(total number of white blood cells,cereal third transaminase,transpeptidase,total bilirubin,calcitonin original(PCT)and c-reactive protein(CRP),albumin,serum amylase)has no statistical difference(P > 0.05),comparable.2.The total operation time of ERCP group was significantly shorter than that of CBDE group [(47±20)min than(180±65.5)min,P<0.05].There was no significant difference in the incidence of intraoperative adverse events between the two groups [0.91%(1/110)vs.2.22%(2/90),P > 0.05].The intraoperative stone clearance rate of ERCP group was 86.36%(95/110),and that of CBDE group was 97.78%(88/90),with statistically significant differences(P < 0.05).3.The postoperative feeding time of ERCP group [(42±24)h ratio(72±48)h],postoperative anal exhaust time [(24±24)h ratio(60±24)h],andpostoperative defecation time [(48±42)h ratio(96±24)h] were all earlier than that of CBDE group(P < 0.05).4.On the third day after the operation,the number of total white blood cells decreased in ERCP group [(5.56±7.48)10^9/L ratio(4.24±6.93)10^9/L],the number of total bilirubin decreased in ERCP group [(17.4 ± 35.48)10^9/L ratio(8.25±15.63)mol /L ratio),and the number of PCT decreased in ERCP group [(0.58±1.01)ug/L ratio(0.2±0.3)ug/L)were all higher than those in CBDE group.The reduced amount of albumin [(3.3±6.4)g/L ratio(5.25±4.78)g/L)was lower than that of the CBDE group,with statistically significant differences(P <0.05).5.The incidence of postoperative hyperamylasemia in the ERCP group was significantly higher than that in the CBDE group [19.09%(21/110)vs.2.22%(2/90)],the incidence of abdominal infection [0.00%(0/110)vs.5.56%(5/110)] and the incidence of incision infection [0.00%(0/110)vs.6.67%(6/110)],and the differences were statistically significant(P < 0.05).6.The total length of stay in ERCP group[(14.4±12)d ratio(24.5±12)h],postoperative length of stay [(8±7.75)d ratio(16.5±11.75)d],and total cost of stay [(33029.17±23685.81)yuan ratio(49406.50±16611.85)] were all lower than those in the CBDE group,and the differences were statistically significant(P < 0.05).7.The recurrence rate of calculi in ERCP group was slightly higher than that in CBDE group [16.36%(18/110)versus 11.11%(10/90),P < 0.05].Conclusion: The efficacy and safety of ERCP for elderly patients with choledocholithiasis complicated with acute cholangitis are comparable to that of CBDE,but the operation time is shorter,the rate of postoperative infectious complications is lower,the postoperative recovery is faster,and the hospitalization time and cost are lower.ERCP can be the preferred treatment for elderly patients with choledocholithiasis complicated with acute cholangitis.