| Objective:Giving consideration to the efficacy,hospital stay,hospitalization costs,and complication rate of patients with gallstones and common bile duct stones,this essay aim to explore the most appropriate treatment options by comparatively analyzing of One-step(LC+LCBDE)and step-by-step(ERCP/EST+LC)surgical methods.Methods:We first collected medical records of 77 patients with gallstones and common bile duct stones,who received minimally invasive treatment from September 2015 to October 2017 at the First Affiliated Hospital of Kunming Medical University.Among these records,there were 43 patients receiving one-step(LC+LCBDE)treatment and 34 patients undergoing step-by-step(ERCP/EST+LC)treatment.Then,we made a comprehensive analysis of these patients in terms of gender,age,length of stay,hospitalization costs,stone exhaustion rate,surgical success rate,total operation time,intraoperative blood loss,postoperative ventilation time and complications.At last,statistical analysis by software SPSS 17.0 was used to perform statistical analysis of the collected data.Results:A total of 77 cases were included in the study.Among them,there were 43 patients in the one-step group,including 18 males and 25 females,with an average age of(51.16±11.822)years.And in the one-step group,15 people suffered from diabetes or hypertension,10 out of 15 having diabetes,13 hypertension,and 8 diabetes with high blood pressure;The average operation time was(173.21±39.164)min;the average total surgical blood loss was(55.91±42.011)ml;the success rate of surgery is 95.349%,which means 41 patients undergoing successful operation,but 2 failing.One turned to laparotomy due to stones incarcerated in the common bile duct at the lower end of the common bile duct,another with severe gallbladder adhesions leading to difficultly separate turned to open abdomen;the average postoperative exhaust time was(3.19±0.906)days;2 cases of bile leakage occurred,recovered after foll drainage;1 case of hemorrhage,self-recovery after drainage plus hemostatic drags;the stone exhaustion rate in once time is 97.56%;the average hospital stay was(15.21±5.527)days;the average hospital cost is(28785.6107±6190.98619)yuan.There were 34 patients in the step-by-step group,including 15 males and 19 females with an average age of(55.97±12.949)years.In the one-step group,13 patients suffered from diabetes or hypertension,8 out of 13 having diabetes,10 hypertension,and 5 diabetes also with high blood pressure;the average operation time was(148.622±40.989)min;the average of total surgical blood loss was(55.91±42.011)ml;there were 33 patients with successful operation in the step-by-step group expect for 1 patient who converted to laparotomy due to intubation failure,and thus the success rate of the operation was 97.959%;the average time of postoperative exhaust was(3.50±0.896)days;7 cases of hyperamylasemia after operation were controlled after the use of somatostatin.One case of hemorrhage was stopped after adding hemostatic drugs;the rate of stone exhaustion in one operation is 96.97%;The average time of hospital stay was(18.85±2.914)days;the average cost of hospitalization is(35204.6826±4427.93855)yuan.There were differences between the two groups in the operation time,hospitalization costs,length of stay,and postoperative complication rate,and thus it has statistical significance(P<0.05);while there was no statistically significant difference(P>0.05)in gender,age,hypertension and diabetes status,success rate of operation,total surgical blood loss,postoperative ventilation time,and stone exhaustion rate.Conclusion:1.Boththe one-step method and the step-by-step method are effective and safe surgical methods for the treatment of patients with gallbladder stones and common bile duct stones.Each has its own advantages and disadvantages.2.Compared with the step-by-step method,the one-step method has shorter hospital stay,lower hospitalization cost,and does not cause damage to the nipple function.In the absence of one-step surgical contraindications,one-step method should be preferred.3.Compared with the one-step method,the operative time of the step-by-step method is shorter and it is not necessary for patients to take the T-tube out of the hospital.With a common bile duct whose diameter is less than 0.5 cm,the patient should give priority to the step-by-step method because of difficulty in accessing the biliary tract into the common bile duct.4.Before surgery,various surgical methods and indications should be evaluated according to the specific conditions of the patient.Then,we should make a personalized optimal treatment plan to each patient. |
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