| Background Endoscopic technique has been widely used to treat cholangiopancreatic diseases , and endoscopic sphincterotomy (EST) is an chief therapeutics for choledocholithiasis. The short-term therapeutic efficacy of EST is better than open surgery(OS) for less wound,less complications and shorter hospitalstay. But we can not ignore the late complications of this therapeutics. Also,it is not clear that if the long-term therapeutic efficacy of EST better than OS.Objective Investigate the effect of endoscopic sphincterotomy (EST) for choledocholithiasis. To compare the early effect of endoscopy and open surgery(OS) for treating choledocholithiasis and Cholecysto-choledocholithiasis, and summarize the rate of late complications of them .To evaluate the prostecdtive efficacy of EST for the treatment of choledocholithiasis.Methods:1,Between July 1987 and May 2007, 991 cases of choledocholithiasis treated with EST were reviewed.2,Then, a retrospective study was adopted to analyze the clinical data of 496 patients of choledocholithiasis or cholecystocholedocholithiasis from March 2001 to March 2007,which were treated with endoscopic sphincterotomy(EST) or EST combine Laparoscopic Cholecystectomy (EST+LC) and open surgery (open cholecystectomy and open choledocholithotimy T-tube drainage,OC+OCHTD). 334 patients were treated by EST or EST+LC, and 162 patients were treated by open surgery.3,The clinical date,such as clearance rate of stones, time of procedure, early complications and hospitalstay, of two groups was contrasted.4,Then, all patients were followed up, the rate of late complications of two groups were statistical analyzed.Results:Among all cases in past 20 years,The common bile duct stones were removed in 909 cases (91.73%).The rate of complications after EST was 5.95%.Between March 2001 to March 2007,the clearance rate of stones was 94.01% in EST group(314/334), and 95.68% in OS group(155/162). There was no statistical difference in two groups(P>0.05). But the average time of operative procedure of EST group( 39.60 minutes) was shorter than OS group(187.75 minutes) (P<0.05). Early complications of the OS group is more than that of the EST group, and also the hospitalstay of two groups was statistical different. 383 patients had been followed up for 12-84months (mean 40.1 months). There were 63 cases(16.45%) of late complications, 38 cases(15.14%)for EST group and 25 cases(18.94%)for OS group, and respectively, 11vs13 cases (4.38%vs9.85%)of recurrent stones, 10vs4 cases (3.98%vs3.03%)of chronic cholangitis, 4vs7 cases (1.59%vs5.30 % )of stenosis, 3vs1 cases (1.20 % vs0.76 % )of chronic or acute pancreatitis.There were 88cases in EST group with gallbladder in situ, among them, acute cholecystitis occurred in 7cases and cholecystolithiasis occurred in 2cases.There was not any case of carcinoma of gallbladder, but we found 1 case of cholangiocarcinoma 5 years after EST. The rate of recurrent stones and stenosis of OS group were significant higher than EST group(P<0.05). But there were not any complications of gallbladder in OS group.Conclusions Endoscopic treatment for choledocholithiasis is safe, effective and less invasive. Comparing with open surgery, this method has the virtue of less complications ,shorter time of operative procedure and hospitalstay.There were few late complications after EST,and compared with open surgery ,there were less recurrence of stones and stenosis after EST. Moreover, therapeutic endoscopy can be perform repeatedly。...
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