| Cholelithiasis is a common and frequently occurring disease in biliary surgery,which refers to the formation of gallstones in any part of the gallbladder,intrahepatic and extrahepatic bile ducts.Because of its complex causes,there is no effective preventive measures,so the treatment is particularly important.At present,the treatment of cholelithiasis,due to non-surgical treatment can not achieve the desired effect,so the use of surgical treatment.In the treatment of cholecystolithiasis,laparoscopic cholecystectomy(LC)is often the first choice.In the patients with cholecystolithiasis and choledocholithiasis,LC alone can not achieve the ideal curative effect,often combined with endoscopic treatment.Endoscopic retrograde cholangiopancreatography(ERCP),as a safe and effective technique for the diagnosis and treatment of common bile duct stones,is the first choice for many surgeons.In the treatment of cholecystolithiasis combined with choledocholithiasis,ERCP combined with LC has the characteristics of good clinical effect,small trauma and high combined application value,which is the preferred treatment strategy for cholecystolithiasis combined with choledocholithiasis.ERCP as an invasive means of examination and treatment,in the treatment of primary diseases at the same time,will undoubtedly have a certain impact on the patient’s body,such as the induction of local inflammation,injury of sphincter of Oddi(SO)and so on,and these effects will affect the subsequent implementation of LC.This study explored the effect of ERCP on LC,so as to provide a comprehensive and systematic basis for different individuals to choose the most reasonable surgical method and improve the treatment efficiency.Objective:This study evaluated the effect of ERCP on LC in the treatment of cholelithiasis by studying whether ERCP increased the difficulty of LC operation before operation,whether it increased the complications during and after LC operation,and whether it affected the bacterial flora of biliary system.To provide a more comprehensive and systematic experimental basis for the clinical use of endoscopy combined with laparoscopy in the treatment of cholelithiasis.Methods:According to the patient’s disease diagnosis and the corresponding operation method,select the patients who meet the standard,and collect the relevant data.According to the inclusion and exclusion criteria,a total of 279 patients with cholelithiasis underwent LC in the Department of general surgery of Chengde Central Hospital from November 2018 to November 2020 were collected.The patients were divided into the observation group(ERCP +LC,96 cases)and the control group(LC,183 cases).In the 96 patients in the observation group,51 patients were diagnosed as cholecystolithiasis and choledocholithiasis,without signs of acute cholecystitis and acute cholangitis;45 patients were diagnosed as cholecystolithiasis with acute cholecystitis and choledocholithiasis with acute cholangitis.In 183 cases of the control group,according to the pathology of patients with gallbladder surgery,excluding 11 cases of patients with gallbladder polyps,gallbladder adenomyosis,172 cases of the control group,including 93 cases of patients without acute cholecystitis;79 cases of patients with acute cholecystitis.1.In the observation group of 51 patients diagnosed as cholecystolithiasis and choledocholithiasis without signs of acute cholecystitis and acute cholangitis,and the control group of 93 patients diagnosed as cholecystolithiasis without acute cholecystitis,propensity matching was performed to eliminate age,gender,body mass index(BMI)and Charlson comorbidity index(CCI),the final group A: 46 cases in the observation group,46 cases in the control group.2.In 45 cases of cholecystolithiasis with acute cholecystitis,choledocholithiasis with acute cholangitis in the observation group and 79 cases of cholecystolithiasis with acute cholecystitis in the control group,the two groups of patients were matched to eliminate the differences in age,gender,BMI and CCI.Finally,group B: 40 cases in the observation group and 40 cases in the control group.The patients in the observation group received ERCP under conscious analgesia,and received laparoscopic cholecystectomy under general anesthesia as soon as possible according to the postoperative recovery of ERCP;the patients in the control group only received laparoscopic cholecystectomy under general anesthesia.In all patients,if the adhesion around the gallbladder is dense,the anatomy of the gallbladder triangle is difficult,and the location of the common bile duct and the relationship between the surrounding tissues can not be determined,laparoscopic subtotal cholecystectomy is performed instead of conversion to laparotomy to avoid bile duct injury and other complications.Recording indicators: 1.Operation duration;2.Intraoperative blood loss;3.Degree of adhesion;4.Degree of inflammation;5.Technical difficulty;6.Subtotal cholecystectomy rate;7.Postoperative biliary tract related complications;8.Bile bacterial culture.Collect the relevant data of the two groups of patients for statistical analysis.In all the analysis,when p < 0.05 means that the difference is significant,it is considered statistically significant.Results:All patients were operated smoothly without anesthesia accident and intraoperative side effects.In group A,in the comparison of operation duration,intraoperative blood loss,degree of adhesion,degree of inflammation and technical difficulty,P values of the two groups were less than 0.05,with statistical significance,indicating that in the absence of acute biliary tract infection,ERCP will increase the degree of adhesion and inflammation around the gallbladder,thus increasing the operation duration,intraoperative blood loss and operation difficulty of follow-up LC After comparing the subtotal cholecystectomy rate,postoperative biliary tract related complications and bile bacterial culture,the P values were greater than 0.05,which showed that there was no significant difference between the ERCP + LC group and the simple LC group in these aspects in the absence of acute biliary tract infection.In group B,the operation duration,intraoperative blood loss,degree of adhesion,degree of inflammation,technical difficulty,subtotal cholecystectomy rate,postoperative biliary tract related complications and bile bacterial culture results of the two groups were compared,all P values were greater than 0.05,there was no statistical significance,indicating that in patients with acute biliary tract infection,ERCP + LC group and simple LC group had no significant difference in these aspects.Conclusion:1.In patients without acute biliary tract infection,preoperative ERCP can increase the difficulty of LC by inducing local inflammation.Therefore,surgeons with rich experience and mature technology are needed to avoid complications such as bile duct injury.2.In patients with acute biliary tract infection,preoperative ERCP is more effective in relieving biliary obstruction and inflammation than in inducing local inflammation in most cases,so it usually does not increase the difficulty of subsequent LC. |
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