Evaluate The Clinical Application Of The Laparoscopic Cholecystectomy Combined The Intraoperative Endoscopic Sphincterotomy In The Treatment Of Cholecystocholedocholithiasis

Objective To evaluate the feasibility and safety of the laparoendoscopic intraoperativerendezvous technique for the treatment of cholecystocholedocholithiasis. Methods: The firststage To analyse the108patients （44male,64female） with cholecystocholedocholithiasiswere treated by the laparoendoscopic intraoperative rendezvous technique.95patients hadperformed the intraoperative EST with the guidewire,13patients had performed the traditionalEST.The operative time,the success rate and the rate of complicati-on were observed. Thesecond stage Application the prospective controlled method to study LC combined preoperativeendoscopic sphincterotomy（POEST） and LC combined IOEST for the treadment ofcholecystocholedocholithiasis. The patients who were diagnosed the cholecystocholedocholithiasisfrom June2012to February2013were divided into POEST group and IOEST group. Everygroups performed50patients. The surgical time, successfull stone-extraction rate, residual stonesrate, complication rate, postoperative stay and hospitalization cost between the groups werecompared. Results: The first stage Ninety-five out of108patients passed the guidewire throughthe cystic duct to performed the intraoperative laparoscopic cholangiography, all the95patientshad performed the intra-operative EST with the guidewire.The mean operative time of theintraoperative EST was19.7min（range10--45min）. Three out of the95patients hadpostoperative hyperamylasemia （3.2%）, no acute pancrea-titis occured. Twelve out of theother13patients had performed the traditional EST,one patient difficulty to papilla cannulation ofthe traditional EST converted to laparoscopic common bile duct stones exploration （LCBDE）because of juxtapapillary divertricula.The mean operative time of the intraoperative EST was20min （range15-34min）. Two out of the13patients had the acute pancreatitis （15.4%）. Theone-step procedure （with and without the guidewire） was possible in107of108patients（99.1%）.The second stage The sexuality, age, stone size, number of stones and diameter ofcommon bile duct were no significant difference between POEST group and IOEST group（P>0.05）. There were no differences between two groups in operative success rate, surgical time of EST, surgical time of LC combined EST, successfull stone-extraction rate andhospitalization cost（P>0.05）. There were significant differences between two groups in residualstones rate, postoperative hyperamylasemia rate, postoperative acute pancreatitis rate andpostoperative stay（P<0.05）. LC combined IOEST with the antegrade insertion of guidewiretechnique significantly reduced the residual stones rate（0vs8%）, postoperativehyperamylasemia rate（4%vs18%）, postoperative acute pancreatitis rate（0vs8%） andpostoperative stay. Conclutions: LC combined IOEST with the antegrade guidewire techniquewith higher success rate and lower suffering allowed one to perform LC and EST only one-step oftreatment, it can be performed safety. Compared with the traditional sequential technique,LCcombined IOEST with the antegrade guidewire technique significant reduced postoperative acutepancreatitis rate and residual stones rate.LC combined IOEST with the antegrade guidewiretechnique should be the recommendation technology of LC combined IOEST to treat patients ofcholecystocholedocholithiasis.