The Comparison Study Of Choledochoscopic Minimally Invasive Cholecystolithotomy With Gallbladder Preserved And Laparoscopic Cholecystectomy In Treatment Of Cholecystolithiasis

Background: Cholecystolithiasis is a common disease in the clinics, the incidence rate of which is about 10% of the normal population. There are many methods of the treatment of Cholecystolithiasis, such as stone-crush, stone dissolution, choleretic treatment and surgery. Since Langenbuch finished the first open cholecystectomy in 1882 and then presented well-known theory, named "breeding grounds for the doctrine", open cholecystectomy has gradually becomed the "gold standard" for the treatment of cholecystolithiasis. However, it was still being argued whether gallbladder of the patients with gallstones should be removed or not. The traditional fistulation for preservation of gallbladder to treat cholecystolithiasis had been abandoned, because of the high frequency of recurrence. Instead, in recent years, the choledochoscopic minimally invasive cholecystolithotomy with gallbladder preserved (CMIC), the choledochoscope assisted by laparoscopy for preservation of gallbladder (CLPG) and laparoscopy combined with choledochoscope for preservation of gallbladder (LCPG) have been proved their benefits on the treatment of cholecystolithiasis. So, the surgery for preservation of gallbladder comes true today.Objective: To compare the treatment efficacy between the minimally invasive endoscopic cholecystolithotomy with gallbladder preserved and laparoscopic cholecystectomy. To explore the surgical indications and contraindications, and to evaluate the therapeutic efficacy and the application prospect of the minimally invasive endoscopic cholecystolithotomy with gallbladder preserved.Methods: A retrospective evaluation of 50 patients who underwent minimally invasive endoscopic cholecystolithotomy with gallbladder preserved (group A) and 2817 patients who underwent laparoscopic cholecystectomy (group B) in Peking university Shenzhe hospital and Shenzhen hospital of TCM from June 2005 to October 2009 is used to collect preoperative clinical data, operative time, postoperative complications (bile leak, hemorrhage, infection), postoperative hospital stay, and total hospital costs. The patients from group A are followed up to collect the recurrence rate of cholecystolithiasis.Results: Total hospital costs is no significant difference between the two groups (8364. 87士836. 62 vs 8225. 70士691. 91RMB, P>0. 05). Operation time of group A is longer than group B(85.27士20.07 vs 60.44士15.60 min, P<0.05). The hospitalized time is longer than that of the LC group (6.88士1.97 vs 4. 96士1.35d, P<0.05). There is no short-term complication in two groups. The recurrence rate of cholecystolithiasis of group A is 20.5%.Conclusions: With the premise of the strict screening surgical indications, it is safe and feasible to treat cholecystolithiasis by the choledochoscopic minimally invasive cholecystolithotomy with gallbladder preserved. But there still have a certain recurrence rate.