Retrospective Study Of Different Treatments For Recurrent Choledocholithiasis After Biliary Tract Surgery

Background：Common bile duct stones is a common disease, with technologicaladvancements, surgical treatments for biliary tract disease increased, and efficacygradually improved, but the stones are often recurrent after biliary tract surgery,postoperative patients with biliary abdominal surgery is far more than the other organswhich need surgical treatment again, recurrent choledocholithiasis after biliary tractsurgery not only seriously affected the health of people, but also increased the economicburden on patients, it is a problem which surgeon must solve. Therefore, for patientswith choledocholithiasis after biliary tract surgery, it is very significant to choose theright treatment for obtaining a satisfactory therapeutic effect and reducing the pain andthe economic burden of patients. There are three main methods for choledocholithiasis:open common bile duct exploration(OCBDE),laparoscopic common bile ductexploration(LCBDE)and endoscopic retrograde holangiopancreatography(ERCP).Objective:Compare three methods of LCBDE, OCBDE and ERCP for recurrentcholedocholithiasis after biliary tract surgery.Method：A retrospective analysis of79cases of recurrent choledocholithiasis afterbiliary tract surgery who were treated in the First Affiliated Hospital of Dalian MedicalUniversity from Jan,2006to Feb,2014.Forty-five of them were treated by ERCP,twenty-four were treated by ERCP,and another ten were treated by LCBDE.We comparethe age and sex composition, operation time, average time of stay in hospital aftersurgery, recovery time of gastrointestinal function, the success rates of surgery and thetype and incidence of complicationsResult：The group research a total of79cases of recurrent choledocholithiasis after biliary tract surgery,38males and41females,the average age is68.8±11.7years old.The average age of Patients in group A is75±12.1years old,group B is64±11.8yearsold, group C is70.6±10.4years old, group B and group A’s age are statisticallydifferent (P <0.05), group B and group C’s age are statistically different (P <0.05). Thesurgery success rates of group A is91.1%,group B is95.9%，group C is90%. Thedifference is not statistically significant (P>0.05).The mean operation time of group Ais35.6±7.89min,Group B is120±33.9min, Group C is198.6±37.2min. Comparison ofthe mean operation time of three groups is statistically different(P <0.05). The averagetime of stay in hospital after surgery of group A is4.12±1.5d,group B is11.3±1.2d,group C is9.6±3.2d. Comparison of the time of stay in hospital after surgery ofthree groups is statistically different(P <0.05).The recovery time of gastrointestinalfunction of group B is2.7±0.9d, group C is1.6±0.7d. Comparison of the recovery time ofgastrointestinal function of three groups is statistically different(P <0.05). Thecomplication rate of group A is2.2%, group B is12.5%,group C is10%. The differenceof complication rate was not statistically significant (P>0.05).Conclusion：The operation time and the hospitalization time after surgery of OCBDEand LCBDE are longer than ERCP. Gastrointestinal function are affected after OCBDEand LCBDE.There are advantages in the treatment for recurrent choledocholithiasisafter biliary tract surgery by ERCP. Three treatment methods have advantages anddisadvantages. One can not be completely replaced by other methods. For differentpatients,we should choose the best methods of treatment.