| Objective: To compare the effect of the LCBDE combined with LC and EST combined with LC to evaluate the value of LCBDE+LC for the treatment of Cholecystocholedocholithiasis.Methods: A retrospective study was adopted to analyze compara- tively the clinical date of 124 patients of Cholecystocholedocholithiasis, treated with different minimal invasive ways during July 2004 to June 2008 in our hospital. According to the surgical approach, all the patients were divided into two groups: laparoscopic common bile duct exploration plus LC (LCBDE+LC group,76 cases), and endoscopic sphincterotomy plus LC (EST+LC group,48 cases). All the patients were followed by a questionnaire after dismissed from hospital. The treatment success rate, complications, the bile duct retained stones, the recovery time of gastrointestinal function, the hospital-stay and the fee were contrasted and underwent statistical analyze.Resluts: LCBDE+LC group:The success rate of operation is 94.74%. 2 cases were conversed to open abdominal operation (OC+OCHTD), 1 case for the reason of serious Intraabdominal adhesions, 1 case for the reason of variation of cysticus and 1 case for the reason of hyperphlogosis around the gallbladder and bile duct. The incidence of postoperative complication is 6.94%: The bile leakage were found in 3 cases and bile duct recurrent stones were found in 2 cases. EST+LC group: Complete removal of bile duct stones were achieved in 46 of 48 patients(95.83%); 2 cases were conversed to laparoscopic procedure (LC+LCTD) for the stones extraction failure. The incidence of postoperative complication is 13.04%. intra-abdominal bleed- ing in 1 case, acute pancreatitis in 4 cases, remnant stones in 1 cases. There was no significant difference in the treatment success rate (P>0.05).There was significant difference in the incidence of postoperative complications between group EST+LC and group LCBDE+LC (P<0.05), and the postope- rative compliations of the LCBDE+LC group were less serious than that of the EST+LC group. The operation time and the fee for the hospital-stay between two groups was different in statistics(P<0.05), but no statistical difference in the rate of conversation to open procedure, the gastroenteric function recovery and hospital-stay(P>0.05). The comparision between the T-tube drainage group and primary closure of common bile duct group appears that the choice is according to the diameter of common bile duct and the amount of stones before the operation, rather than the size of stones. At follow-up time of 3～28 months(mean16.4 months)in 96 patients, no common bile duct cholangitis and stricturer occured. There was no morta- lity in both groups.Conclusions: LCBDE+LC and EST+LC are two minimal invasive approach, both of which are safe, effective and feasible for the treatment of Cholecystocholedocholithiasis. Compared with EST+LC, LCBDE+LC have short fasting-time, low complication rate and less eccnomic burden during hospital-stay. Primary closure of the common bile duct in suitable cases would bring advangtage of the minimal invasive techniques. It brings out an positive effect, so will have an increasingly wide utilization in Biliary Surgery.
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