Endoscopic Sphincterotomy And Surgical Treatment Of Choledocholithiasis: A Long-term Follow-up Study

Background:Some studies suggest that endoscopic sphincterotomy(EST)destroys the duodenal sphincter,changes the normal physiological structure and leads to some long-term complications,such as recurrence of stones,cholangiocarcinoma,etc.Hence,the clinical application of EST is limited.There are a lot of studies on the long-term complications of EST,but there are few long-term follow-up studies compared with surgical treatment of choledocholithiasis.In this study,a long-term follow-up of choledocholithotomy and EST lithotomy and compare the short and long-term complications.Objective:In this study,the operation and complications of endoscopic sphincterotomy and surgical treatment of choledocholithiasis were observed.The recent complications including bleeding,perforation,pancreatitis,cholangitis,bile leakage,intraperitoneal infection,postoperative adhesive intestinal obstruction,incision infection,long-term complications such as calculi recurrence,cholangiocarcinoma,papillary stenosis,bile duct stenosis,reflux cholangitis,etc.The risk factors of stone recurrence were analyzed in order to analyze the advantages and disadvantages of treatment methods and to guide the clinical selection of reasonable treatment methods.Methods:From January 2009 to December 2012,350 patients with choledocholithiasis were hospitalized in the Department of Digestive or General surgery in our hospital.According to the department of final choledocholithiasis treatment,they were divided into endoscopic treatment group(group A)and surgical group(group B).Among them,185 were included in Group A,165 persons included in Group B.A long-term follow-up study was conducted to analyze and compare the operation time,anesthesia time,time to relieve obstruction,etc of the two groups.The most impotant was analyzed the short-and long-term complications.Results:Of 350 patients with choledocholithiasis,302 patients received complete follow-up data,the success rate was 86.3%,and the average follow-up was 72.9 months.The surgical group consisted of 65 males and 69 females,with an average age of 57 years,while the endoscopic therapy group consisted of 73 males and 95 females,with an average age of 54 years.The average hospitalization days in the surgical group were significantly longer than those in the endoscopic treatment group(P < 0.05).Because of the slow recovery after surgery,the hospitalization time was significantly longer than that in the endoscopic treatment group.There was no significant difference between surgical operation group and endoscopic treatment group(P > 0.05).The time of relieving obstruction in surgical operation group was longer than that in endoscopic treatment group(P < 0.05),and the anesthesia time in surgical operation group was longer than that in endoscopic treatment group.The operative time in the surgical group was significantly longer than that in the endoscopic treatment group(P < 0.05),the difference was statistically significant(P < 0.05),and the difference was statistically significant in the surgical operation group(P < 0.05).There were 12 cases of short-term complications in the surgical group and 9 cases in the endoscopic group.There was no significant difference between the two groups(P > 0.05).In the surgical group,there were 37 cases with recurrent stones in the long term,40 cases in the endoscopic treatment group,and 40 cases in the endoscopic treatment group.The difference was insignificant(P > 0.05).There were 2 cases of cholangiocarcinoma in surgical group and 1 case of cholangiocarcinoma in the group of surgery,and 0 cases in the group of endoscopic treatment.There was no significant difference(P > 0.05).Logistic regression analysis showed that the diameter of common bile duct was more than 15 mm,and the multiple stones were significantly correlated with the recurrence of stones.Conclusions:The amount of operation time and anesthetic time of EST in treating choledocholithiasis were less than those in the surgical group.For the patients with acute cholangitis,EST could relieve the obstruction more quickly.EST could relieve the long-term complications such as recurrence of choledocholithiasis in patients with choledocholithiasis,such as recurrent choledocholithiasis.Cholangiocarcinoma is lower than surgical choledocholithiasis.The risk factors for the recurrence of long term complications are various.This study found that the number of stones and the diameter of common bile duct ? 15 mm were associated with the recurrence of long term stones.There is no confirmed connection with EST.We believe that EST lithotripsy is a safe and effective treatment for choledocholithiasis both in recent and long term complications.