Retrospective Study Of Endoscopic-laparoscopic Technique For Gallbladder Stone With Common Bile Duct Stones

Background:Cholelithiasis is a common disease in clinic,with an incidence of 10%-15%.With the improvement of living standard and the changes in diet,the incidence of cholelithiasis is increasing.Choledocholithiasis is identified in approximately 9.2%-33%of patients with CBDS.Gallbladder stone with CBDS can cause acute cholangitis,acute pancreatitis and other serious complications easily,and the course of the disease is shot.Currently the main treatment for this disease is operation.The open cholecytectomy + open choledocholithotomy with T-tube Drainage(OC+OCH+TD)is the normal therapy for cholecystolithiasis combined with common bile duct stones(CBDS).Because of the accumulation of experience in operating endoscopes and the concept of minimally invasive accepted deeply,the treatment appeared great changes.There are 2 kinds of minimally invasive treatment methods commonly used in China:laparoscopic cholecystectomy +endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy(LC+ERCP/EST),and LC + paroscopie common bile duct exploration(LC+LCBDE).Two kinds of treatment methods can be used to treat cholecysto-lithiasis with choledocholithiasis,but the two methods have their own characteristics.However,the choice of the method is still controversial.Objective:To compare the clinical efficacy of LC+LCBDE and LC+ERCP/EST in the treatment of gallbladder stone combine with CBDS,and explore the best treatment option.Methods:The data of 81 patients with gallbladder stone combine with CBDS,who were hospitalized in Zhongda Hospital Southeast University from January 2015 to December 2016,was collected for a clinical retrospective analysis.All patients were divided into two groups,according to their different methods of minimally invasive treatment:33cases in the ERCP/EST+LC group accepted the method of endoscopic sphincterotomy combined with laparoscopic cholecystectomy.48cases in the LCBDE+LC group accepted the method of laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy.The operation time,intraoperative bleeding,residual stone rate,the rate of conversion to laparotomy,postoperative ventilation through time,hospitalization time,total cost of hospitalization,postoperative early complications such as statistical comparisons were performed.Using SPSS17.0 medical statistical software for statistical analysis.Results:No statistically significant difference between the two groups was found in terms of age,gender,clinical presentation,liver function,or complications(P>0.05).The two groups in the intraoperative amount of bleeding,the rate of residual stones,the rate of conversion to laparotomy,postoperative ventilation through time,postoperative liver function,average hospitalization time after surgery and early complications had no significant difference,no statistical significance(P>0.05),and at the time of surgery,hospitalization time,total cost of hospitalization on,between the two groups have statistical significance(P<0.05).Conclusions:LC+ERCP/EST and LC+LCBDE shows a successfully treatment of cholecystolithiasis accompanied by common bile duct stones.LC+LCBDE group have a good advantage in the cost of hospitalization,can reduce the economic burden of the patients.Because of the minor surgical trauma,quicker recovery and higher satisfaction,LC+ERCP/EST is more popular.Take the method of "one step" and enhance the inter-disciplinary cooperation could reduce the hospitalization time by LC+ERCP/EST.