The Research Of Operation Time About LC After ERCP For The Management Of Cholecysto-choledocholithiasis

Background:Gallstone is one of the biliary surgery frequently-occurring and common disease,and its morbidity in adults is about 10%, even as high as 15% in middle-aged females.At the same time,as the aged tendency of population and the changes in the structure of people’s diet, its morbidity is increasing.About 10% to 15% of the patients with cholelithiasis have calculus of extrahepatic bile duct. Its mainly clinical symptoms are jaundice, fever, chills, abdominal pain, some with shock and constraints on the central nervous system.Traditional open cholecystectomy, open common bile duct exploration and T tube drainage is classic operation in management of the gallbladder and extrahepatic bile duct stones.With the improvement of people’s living standard and quality, Its status is gradually being substituted by some minimally invasive surgery in recent years. At present the main techniques about minimally invasive surgery are as follows:(1)Laparoscopic combine with choledochoscope:(1) laparoscopic cholecystectomy(LC),laparoscopic common bile duct exploration(LCBDE), choledochoscope exploration(2)laparoscopic cholecystectomy,laparoscopic transcystic common bile duct exploration(LTCBDE),choledochoscope exploration;(2) laparoscope combined with duodenoscope(three patterns):(1) preoperative endoscopic retrograde Cholangiopancreatography(Pre-ERCP),laparoscopic cholecystectomy;(2) intraoperative endoscopic retrograde Cholangiopancreatography(Intra-ERCP), laparoscopic cholecystectomy;(3) postoperative endoscopic retrograde cholangiopancreatography(Post-ERCP),laparoscopic cholecystectomy.With the rapid development of modern minimally invasive technology and quick update of medical equipment, Pre-ERCP combining with LC technique have been widely used in minimally invasive surgery.The clinical research about the best time for LC after ERCP is controversial.This paper is main to explore the best time for LC after ERCP by comparing intra one day for LC after ERCP with intra 2 to 7 days for LC after ERCP. Methods:70 patients of the Second Affiliated Hospital Of Chongqing Medical University’s hepatobiliary surgery with gallbladder stone and choledocholithiasis treated with the LC after ERCP from January 2010 to February 2016 were retrospectively analyzed. Patients( 32 cases) in group A received an ERCP followed by LC within one day.Patients( 38 cases) in group B received an ERCP followed by LC within 2 to 7 days.Indicators related to LC surgery time, total hospital stays, total expenses and complications were recorded respectively. Results :Time of operation, rates of open operation midway and complications were not statistically different between two groups(P>0.05).The total hospital stays and expenses in group B were significantly higher than those in group A(P<0.05)。 Conclusion :ERCP followed by LC within one day for the treatment of gallbladder stone with choledocholithiasis is feasible and safe.At the same time,it shortens the total hospital stay and saves the expense.It is worth clinical promoting.