Clinical Analysis On Laparoscopic Treatment For Elderly Patients With Cholecystocholedocholithiasis

Objectives:Choledocholithiasis and cholecystolithiasis is one of the most common digestive diseases among elderly people.Because elderly patients are often regarded as high-risk patients who are more likely to coexist chronic diseases,no conclusion has been arrived at on whether laparoscopic common bile duct exploration(LCBDE)with laparsocopic cholecystectomy(LC)or endoscopic retrograde cholangiopancreatography(ERCP)/ endoscopic sphincterotomy(EST)with LC is the best approach for elderly patients with choledocholithiasis and cholecystolithiasis.Hence,The objective of this study is to analyze the safety and efficacy of LCBDE+LC in choledocholithiasis and cholecystolithiasis among elderly patients.Methods:From January 2014 to August 2018,480 patients diagnosed with choledocholithiasis and cholecystolithiasis who underwent LCBDE+LC were included in the study and divided into the laparoscopic elderly group(n=259 age?65)and the laparoscopic younger group(n=221 age<65).In addition,From January 2014 to August 2018,110 patients diagnosed with choledocholithiasis and cholecystolithiasis who were 65 years old or older and underwent ERCP/EST+LC were included in the study and defined as endoscopic elderly group(n=110 age?65).The preoperative risks,clinical presentation,laboratory data,operative parameters and postoperative complications were analyzed between the three groups.Results:1.Laparoscopic elderly group vs laparoscopic younger groupPreoperative risk factors including arterial hypertension,heart diseases,pulmonary diseases,diabetes mellitus,liver diseases and cerebrovascular diseases were found more frequently in laparoscopic elderly group(P<0.05).The level of ALT was higher in laparoscopic younger group(P<0.05).In both groups,LCBDE+LC was observed with a high successful duct clearance rate,which was 98.8% in laparoscopic elderly group and 99.1% in laparoscopic younger group(P>0.05).Hospital expenses,postoperative and total hospital stay were found higher in laparoscopic elderly group,and there was significant difference(P<0.05).The morbidity of all related postoperative complications was low in both groups and there was no significant difference between the two groups(P>0.05).During the long-term observation period,except for 42 missing patients,we found 18 cases of recurrent CBD stones totally(18/438,4.1%).There was 7 cases of recurrent stone in laparoscopic younger group and 11 cases of recurrent stones in laparoscopic elderly group,with no significant difference(P>0.05).No patient developed postoperative stricture of the CBD in any group.2.Laparoscopic elderly group vs endoscopic elderly groupAll preoperative risk factors,clinical presentation and laboratory data show no significant difference between laparoscopic elderly group and endoscopic elderly group(P>0.05).LCBDE+LC and ERCP/EST+LC was observed with a high successful duct clearance rate,which was 98.8% in laparoscopic elderly group and 99.1% in endoscopic elderly group(P>0.05).Hospital expenses and total hospital stay were found higher in endoscopic elderly group,and there was significant difference(P<0.05).Duration of surgery was found lower in endoscopic elderly group,and there was significant difference(P<0.05).The morbidity of hyperamylasemia was found higher in endoscopic elderly group,and there was significant difference(P<0.05).The morbidity of other related postoperative complications was low in both groups and there was no significant difference between the two groups(P>0.05).During the long-term observation period,except for 39 missing patients,we found 15 cases of recurrent CBD stones totally(15/330,4.5%).There were 4 cases of recurrent stone in endoscopic elderly group and 11 cases of recurrent stones in laparoscopic elderly group,with no significant difference(P>0.05).No patient developed postoperative stricture of the CBD in any group.Conclusion:Although elderly patients are frequently confronted with coexisting chronic diseases,LCBDE+LC can be considered as a safe and effective approach for elderly patients with cholecystocholedocholithiasis.