Comparison Of ERCP+LC And LCBDE+LC For The Treatment Of Cholecystolithiasis Combined With Choledocholithiasis Using Propensity Score Matching

Background: Cholecystolithiasis combined with choledocholithiasis is a common biliary tract disease,which seriously affects the quality of life and health of patients.The traditional treatment method is laparotomy,but this method has great trauma,many complications and slow recovery,which causes great pain and trouble to patients.In recent years,with the progress of minimally invasive technology and concept,minimally invasive treatment has gradually become the mainstream.At present,the minimally invasive surgical methods for the treatment of cholecystolithiasis complicated with common bile duct stones mainly include ERCP+LC and LCBDE+LC,but these two surgical methods have their own advantages and disadvantages,and there is no unified standard and consensus at present.Objective: The aim of this study was to retrospectively analyze the treatment outcomes of minimally invasive treatment for patients with gallbladder stones combined with common bile duct stones in the Department of Hepatobiliary and Pancreatic Surgery at the First Affiliated Hospital of the University of Science and Technology of China,and to compare the efficacy of different surgical approaches,namely ERCP+LC and LCBDE+LC,using methods such as propensity score matching(PSM).The study aimed to evaluate the advantages and disadvantages of these two approaches,in order to provide reliable decision-making guidance for clinical physicians.Methods: From January 2019 to June 2021,clinical data of 317 patients with cholecystolithiasis and choledocholithiasis who met the corresponding inclusion and exclusion criteria were collected from the Department of Hepatobiliary Surgery at the First Affiliated Hospital of the University of Science and Technology of China.Among them,100 patients underwent ERCP+LC,and 217 patients underwent LCBDE+LC.In order to reduce the impact of imbalanced variables on outcome measures between the ERCP+LC and LCBDE+LC groups before matching,a 1:1 propensity score matching method was conducted.After matching,the efficacy and safety of ERCP+LC and LCBDE+LC were compared in terms of stone clearance rate,operation time,postoperative hospital stay,hospitalization cost,changes in WBC,ALT,AST,TBIL,and ALB before and after surgery,as well as the incidence of postoperative complications such as hyperamylasemia or acute pancreatitis,bile leakage,biliary tract infection,wound infection,and abdominal fluid accumulation.Multiple aspects were evaluated to provide reliable decision-making basis for clinical physicians.Results: After 1:1 propensity score matching,76 patients in each group were included,with no significant differences in baseline characteristics between the ERCP+LC group and the LCBDE+LC group(P>0.05).After matching,there were no statistically significant differences between the two groups in terms of stone clearance rate,postoperative levels of ALT,AST,TBIL,ALB,the differences in levels of ALT,AST,and TBIL before and after surgery,and overall complications(P>0.05).However,there were statistically significant differences between the two groups in terms of operation time,postoperative hospital stay,hospital costs,postoperative WBC,postoperative hyperamylasemia,and intra-abdominal fluid accumulation,as well as pre-and post-operative WBC and ALB levels within each group(P<0.05).Conclusions: The study results demonstrate that both ERCP+LC and LCBDE+LC are safe and feasible minimally invasive treatment options for patients with cholecystolithiasis and common bile duct stones.Each surgical approach has its own advantages and disadvantages.This study provides some reference and guidance for clinicians in selecting the appropriate surgical method for treating cholecystolithiasis and common bile duct stones.However,when choosing a treatment option,clinicians should consider various factors and select the most suitable treatment plan for each individual patient to achieve the best treatment outcome.