Selection Of Minimally Invasive Treatment Options For Extrahepatic Bile Duct Stones With Different Diameter Of Common Bile Duct

Objective: Analysis and evaluation of laparoscopic cholecystectomy with common bile duct exploration(LC + LCBDE)or laparoscopic cholecystectomy with endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy(LC+ERCP+EST)in the same range of common bile duct diameter lithotomy effect of the two procedures,so as to implement optimized treatment plan for patients with different diameters of common bile duct.Methods: According to the inclusion criteria for our hospital(Affiliated Hospital of Youjiang Medical Unversity for Nationalities)from October 2015 to October 2017 a diagnosis of gallbladder and common bile duct stones clinical data of 180 cases were retrospectively analyzed.According to the diameter of common bile duct were divided into three groups,respectively,the use of laparoscopic cholecystectomy with choledocholithiasis lithotomy(LC+LCBDE)or laparoscopic cholecystectomy with endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy(LC+ERCP+EST)two kinds of surgical treatment.Comparison of operative time,postoperative hospital stay,hospitalization costs,success rate of operation,residual rate of stones,and postoperative and long-term complications.Results: 1.Comparison of common bile duct diameter ?1cm group:(1)There was no statistically significant difference in gender,age,clinical manifestation,common bile duct diameter,diameter of common bile duct stones,and number of stones among the two groups(P>0.05).The data were comparable;(2)There were significant differences in postoperative hospital stay,incidence of postoperative pancreatitis,and success rate of operation between the two groups(P<0.05),but the operation time,hospitalization costs,residual rate of stones,and long-term complications were no significant difference between the two groups(P>0.05);2.Comparison of common bile duct diameter 1-2cm group:(1)There was no significant difference in gender,age,clinical manifestation,common bile duct diameter,diameter of common bile duct stones,and number of stones(P>0.05).The data were comparable;(2)There were significant differences in postoperative hospital stay,hospitalization costs,and early postoperative complications between the two groups(P<0.05).The complications of operation time,success rate of surgery,residual stone rate,and postoperative complications were not statistically significant(P>0.05);3.Comparison of common bile duct diameter ?2cm group:(1)There was no statistically significant difference in gender,age,clinical manifestation,common bile duct diameter,common bile duct diameter,and number of stones(P>0.05).The data were comparable;(2)There were significant differences in the operative time,postoperative hospital stay,hospitalization costs,surgical success rate,residual stone rate,and postoperative and long-term total complications between the two groups(P<0.05).Conclusion: 1.LCBDE+LC and ERCP+EST+LC for the treatment of gallbladder stones with common bile duct stones were safe and effective surgical methods.2.When the common bile duct diameter was?1 cm,the length of postoperative hospital stay and the incidence of postoperative pancreatitis were lower in the LTCBDE + LC group than in the ERCP+EST+LC group,but the success rate of the surgery was reduced.3.When the common bile duct diameter was 1-2cm,the length of hospital stay was shorter in the LCBDE+LC group than in the ERCP+EST+LC group,hospitalization costs were reduced,and the incidence of postoperative complications was decreased.4.When the common bile duct diameter was?2cm,the LCBDE+LC group has a higher success rate of surgery compared with the ERCP+EST+LC group.The operation time and postoperative hospital stay were shortened,and hospitalization costs were less,the residual rate of stones and the incidence of postoperative and long-term complications were significantly reduced.