Clinical Study Of LC+LCBDE And LC+Intra-ERCP/EST In The Treatment Of Gallstones Complicated With Common Bile Duct Stones

Objective:To compare the efficacy of laparoscopic cholecystectomy combined with common bile duct exploration(LC+LCBDE)and laparoscopic cholecystectomy combined with intraoperative endoscopic choledocholithotomy(LC+intra-ERCP/EST)in the treatment of cholecystolithiasis and choledocholithiasis,and to evaluate the advantages and disadvantages of the two surgical methods.In order to provide a basis for the selection of clinical treatment options for these patients.Methods:Selecting a total of 103 patients with gallbladder stones combined with common bile duct stones who were treated in Shanxi Provincial People’s Hospital from January 1,2020 to January 1,2022.Cases were divided into LC+LCBDE group(55 cases)and LC+intra-ERCP/EST group(48 cases)according to the surgical method.The baseline characteristics,preoperative laboratory indicators,stones diameter,stones number,common bile duct diameter,conversion to surgery,operation time,intraoperative blood loss,postoperative laboratory indicators,postoperative complications,postoperative abdominal drainage tube removal time,hospitalization time and total hospitalization cost were compared between the two groups.Results:The baseline data of the two groups were balanced and comparable(P>0.05),and there were no significant differences in preoperative laboratory indexes,stone diameter,stone number and common bile duct diameter(P>0.05).Intraoperative blood loss(36.82±39.71 m L)and operative time(2.13±0.60h)in LC+LCBDE group were higher than those in LC+intra-ERCP/EST group(22.40±15.61 m L,1.84±0.29h),and the difference was statistically significant(P(27)0.05),and the surgical turnover rate of the former was higher than that of the latter,and the difference was not statistically significant(P>0.05).There were no significant differences in postoperative laboratory indexes(ALT,AST,TBIL,DBIL,IBIL,GGT,AKP)between the two groups(P>0.05),and all of them were lower than before surgery,the difference was statistically significant(P(27)0.05).While AMY and LPS in LC+intra-ERCP/EST group were higher than LC+LCBDE on the third day after surgery,and the difference was statistically significant(P(27)0.05).There were no statistical differences between the two groups in postoperative hemorrhage,bile leakage,stone residue,cholangitis,incision infection,stone recurrence,and common bile duct stenosis(P>0.05),but the incidence of postoperative pancreatitis in the LC+intra-ERCP/EST group was higher than that in the LC+LCBDE group,and the difference was statistically significant(P(27)0.05).There was no statistical difference in the length of hospital stay between the two groups(P>0.05).The time of abdominal drainage tube removal in LC+LCBDE group was later than that in LC+intra-ERCP/EST group,the difference was statistically significant(P(27)0.05),while the total hospitalization cost in the LC+intra-ERCP/EST group was significantly higher than that in LC+LCBDE group(P(27)0.05).Conclusion:In the treatment of cholecystolithiasis and choledocholithiasis,the two surgical methods can be used to treat gallbladder stones and common bile duct stones at one time,and satisfactory therapeutic effect can be achieved.However,both of them have their shortcomings,LC+LCBDE was associated with more intraoperative hemorrhage and longer tube carrying time.And LC+intra-ERCP/EST was associated with more hospital expense and more pancreatitis.Therefore,the specific surgical method should be evaluated according to the conditions of patients,doctors and medical institutions to form an individualized treatment plan,so that patients can benefit more from it.