| Objective:Conducting a retrospective analysis between different stages of laparoscope and duodenoscope combination regarding the treatment of concomitant cholelithiasis and choledocholithiasis aims at discussing the security and feasibility of different stages of laparoscope and duodenoscope combination treatment.We can make clinical decision by making a comparison of complication or adverse reactions of both group,which can also provide reliable clinical proofs for one-stage laparoscope and duodenoscope combination treatment on cholelithiasis and choledocholithiasis.Methods:According to the inclusion and exclusion criteria,51 patients who were treated with laparoscope and duodenoscope combination were enrolled our study.They were divided into two groups based on the stages when surgeries were underwent,group preoperative ERCP/EST/EPBD/ENBD+LC(group pre-ERCP+LC)and group intraoperative ERCP/EST/EPBD/ENBD+LC(group Io-ERCP+LC).Then to make an analysis of parameters of operations accomplishment,the efficiency of operations,the complication of operations and economical parameters between two groups could evaluate the security and feasibility of this surgery.SPSS 22.0 was used for all data analysis.Independent-Sample T test was used when analyzing measurement data and measurement data was expressed as means ± standard deviations(x ± s).Chi-square test(theoretical frequency>5)and Fisher exact probability(theoretical frequency<5)was used when analyzing enumeration data and enumeration data was expressed as percentage(%),significant level a=0.05,two sides,statistical significance was accepted when P<0.05.Results:Two groups of patients had no statistical significance in basic clinical files like gender,age,laboratory results,child-pugh scores,diameter of gallbladder and common bile duct stones,diameter of common bile duct,two groups are comparable.And based on the results we got two groups of patients had no statistical significance in operation time,bleeding,stone clearance rate and stone residual rate(P>0.05),which indicates that the therapeutic effect of laparoscope and duodenoscope combination is definite.On complications,the total incidence rate of Pre-ERCP+LC and Io-ERCP+LC is 24.1%and 36.4%respectively.However,post-ERCP pancreatitis(PEP)and hyperamylasemia were two main and common complications in both groups and the incidence rate had no statistical significance between them(P>0.05).For other complications,aspiration,digestive tract perforation,acute cholangitis,biliary leakage,bile duct injuries were not observed in the research.Post operation parameters,such as numerical rating scale(NRS),operation cost and hospital stay had statistical significance(P<0.05).Io-ERCP+LC has better NRS score and tolerance of operations,also less surgery cost and shorter hospital stay compared with Pre-ERCP+LC.A 1-3month follow-up for both groups,no stones palindromia or acute cholangitis or other complications are found.Conclusion:Intraoperative and preoperative laparoscope and duodenoscope combination are both effective methods in treating cholelithiasis and choledocholithiasis and they are proved to be safe and feasible and a short period of follow-up shows no any complications reappear.Intraoperative laparoscope and duodenoscope combination has a better decrease in patients pain,surgery cost and hospital stay,more important,an increase in patients satisfaction and tolerance of therapy.It's worthy to be promoted. |
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