| Objectives: To compare the difference of laparoscopic cholecystectomy(LC)combined with intraoperative ERCP in supine or left prone positions and different stages of LC combined with suspine position for ERCP in the treatment of CholecystoCholedocholithiasis,in order to analyze the feasibility and safey of the treatment of gallbladder and common bile duct stones,which can provide a new way of minimally invasive diagnosis and treatment of biliary tract.Methods:40 cases diagnosed gallbladder and common bile duct stones which had undergone LC+ERCP were enrolled from January 2016 to December 2018 in general surgery department of the First Affilitated Hospital of Dalian Medical University.According to different position criteria,they were divided into two groups: LC+ intraoperative ERCP in supine position(group A),23 cases in tota;LC+ intraoperative ERCP in left prone position(group B),17 cases in total.According to the inclusion criteria and exclusion criteria,one case had undergone ERCP in the past,two cases had other large operations due to intraoperative surgery,and one case of repeated stone removal during hospitalization due to multiple large stones in the common bile duct,so they was not included.The data were 36 cases,including 20 cases in group A and 16 in group B.To record the basic conditions of patients(gender,age,hypertension,diabetes,cardiovascular and cerebrovascular diseases),intraoperative vital signs(blood pressure difference,heart rate difference,mean oxygen saturation),Intraoperative biliary tract(diameter of common bile duct diameter,number of common bile duct stones,maximum diameter of common bile duct stones,presence or absence of duodenal diverticulum),Surgical conditions(surgery time,ERCP stone removal time,intubation difficulty),hospitalization time,hospitalization expenses,complication rate(hemorrhage,cholangitis,hyperamylasemia,pancreatitis after ERCP,etc.),and Telephone follow-up(the follow-up content is whether the patient has cholangitisrelated symptoms and symptoms of pancreatitis,etc.),outpatient review,rehospitalization,and we can analyze the clinical therapeutic effect of LC combined with supine ERCP in the treatment of gallbladder combined with common bile duct stones.Results:There were no significant differences in age,gender,hypertension,diabetes,cardiovascular and cerebrovascular diseases between the two groups(P > 0.05).There were no significant differences in intraoperative conditions,systolic blood pressure differences,heart rate differences,and oxygen saturation(P > 0.05).The number of common bile duct stones,the largest diameter of common bile duct stones,duodenal diverticulum,intubation difficulties,total operation time,ERCP time were not statistically significant(P > 0.05).Postoperative complications: There was no significant difference in the amount of bleeding between the two groups,post-ERCP pancreatitis and other complications(P > 0.05).In the case of hyperamylasemia,the hemi-P value was 0.039,indicating that the incidence of hyperamylasemia in group A was higher than that in group B,which was statistically significant.There was no significant difference in postoperative intestinal recovery time,hospitalization time,hospitalization cost between the two groups(P > 0.05).Conclusion: It is Safe and effective of laparoscopic cholecystectomy(LC)combined with intraoperative ERCP in supine positions to treat Cholecysto-Choledocholithiasis.It is especially suitable for patients who cannot be prone and need close monitoring,and facilitates intraoperative anesthesia management and care,but requires a skilled physician to perform minimally invasive techniques.This type of surgery can be promoted in units with appropriate hardware and technical conditions. |
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