Clinical Analysis Of Simultaneous Laparoscopic Cholecystectomy Plus Endoscopic Retrograde Cholangiopancreatography In The Treatment Of Cholecystolithiasis With Choledocholithiasis

BackgroundCholelithiasis refers to the disease caused by stones in any part of the biliary system,which is a common disease in China.Depending on the position of gallstones in the biliary system,it can be divided into cholecystolithiasis,bile duct stones inside and outside the liver.Stones in different parts of the body can exist alone or in the same patient.According to statistics,in cholelithiasis patients of China,nearly 80% of the patients with the stones occur in the gallbladder,about 10%-20% of the cholecystolithiasis patients have choledocholithiasis.Cholecystolithiasis combined with choledocholithiasis is a more complex type,prone to obstructive jaundice and biliary pancreatitis,etc.If not treated in time and the condition continues to develop,liver failure and hepatatrophia may occur,and in serious cases,death may occur.It is clinically recommended to take surgical treatment to remove the stones as soon as possible to restore the patency of the bile duct.At present,the main surgical methods are the following:1、Open cholecystectomy + choledocholithotomy;2 、 laparoscopic cholecystectomy+ laparoscopic common bile duct exploration;3 、laparoscopic cholecystectomy+ endoscopic retrograde cholangiopancreatography.And LC+ERCP can be divided into concurrent LC+ERCP and LC in the second stage after ERCP according to different operative timing.The specific surgical methods should be selected by surgeons according to the specific conditions of patients.ObjectiveBy comparing with the clinical efficacy of LC in the second stage after ERCP in the treatment of cholecystolithiasis with choledocholithiasis,to discuss the clinical application and efficacy of LC+ERCP in the same period.MethodThe clinical data of 62 patients who were diagnosed as cholecystolithiasis with choledocholithiasis in Department of General Surgery of our hospital from October 2018 to March 2020 were reviewed retrospectively.Among them,28 patients who underwent LC combined with ERCP treatment during the same period were divided into the observation group,34 patients who underwent LC in the second stage after ERCP were divided into the control group.Data of surgical patients in the observation group and the control group were summarized as follows:(1)Preoperative statistics,Including age,gender,complications,body mass index(BMI),common bile duct diameter,number and diameter of common bile duct stones,alanine transaminase,total bilirubin,preoperative albumin and preoperative prealbumin,etc;(2)Postoperative statistics,Including postoperative complications,postoperative hospital stay,stone clearance rate,albumin and prealbumin 1 month after surgery.This study was reviewed and approved by the Ethics Committee of Nanyang Central Hospital,and all patients signed informed consent.Results1.There were no significant differences in age,gender,complications,BMI,number and diameter of common bile duct stones between the observation group and the control group(P>0.05).2.The postoperative hospital stay in the observation group was(7.0±1.5)d less than that in the control group(8.8±1.5)d,and the difference was statistically significant(P<0.001).3.The total postoperative complications were 2 cases(7.1%)in the observation group and 3 cases(8.8%)in the control group,and the difference was not statistically significant(P>0.05).4.There was no significant difference in serum prealbumin and albumin levels between 2 groups before operation and 1 month after operation(P>0.05).Serum prealbumin and albumin were higher in observation group 1 month after operation than before operation(t=-8.667,P<0.001;t=-6.819,P<0.001);The levels of albumin and albumin were higher in the control group 1 month after operation than before operation(t=-7.937,P<0.001;t=-6.321,P<0.001).5.On the third or fourth day after surgery,the radiography showed that the biliary duct was unobstructed without residual stones,and the stone clearance rate was 100% in both groups.Conclusion1.LC+ERCP in the same period is safe,effective and feasible in the treatment of cholecystolithiasis with choledocholithiasis2.LC+ERCP has the advantages of quick postoperative recovery and short hospitalization time,and is one of the more ideal surgical methods for the surgical treatment of cholecystolithiasis with choledocholithiasis.