Efficacy Analysis Of LCBDE And ERCP In The Treatment Of Patients With History Of Common Bile Duct Exploration

Objective: To investigate the efficacy of laparoscopic common bile duct exploration(LCBDE)and endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of patients with previous common bile duct exploration.Methods: The clinical data of 97 patients with a history of common bile duct exploration in our hospital from January 2012 to July 2020 were retrospectively collected.According to different treatment methods,patients were divided into LCBDE group(n=41)and ERCP group(n=56),and the baseline characteristics,intraoperative and postoperative outcomes of the two groups were compared and analyzed.Results: The initial stone clearance rate in the LCBDE group was higher than that in the ERCP group(95.1% vs.80.4%,p=0.035),and the final stone clearance rate was comparable between the two groups(100% vs.100%,p=1.000).In the LCBDE group,4 cases(9.8%)were converted to laparotomy,of which 3 cases were converted to laparotomy due to dense adhesions and 1 case of large incarcerated stones;3 cases(5.4%)in the ERCP group failed to remove stones,of which 2 cases were large stones Difficult to remove,1 case of duodenal diverticulum failed intubation was transferred to surgery.Short-term overall complication rates were comparable between the LCBDE and ERCP groups(17.1% vs 16.1%,p=0.896).There were 7 cases of recent complications in the LCBDE group,including 4 cases of biliary fistula,1 case of intra-abdominal infection,1 case of abdominal hemorrhage,and 1 case of gastroduodenal injury,all of which were cured and discharged after treatment.There were 9 cases of recent complications in the ERCP group,including 8 cases of postoperative acute pancreatitis and 1 case of biliary hemorrhage,which were cured and discharged after treatment.In the LCBDE group,the operation time was 190(142.5-242.5)min vs.43.5(36.3-60.8)min,the postoperative hospital stay(7.0 ±6.3vs.4.2±3.5d),and the hospitalization cost was 3.4(2.6-4.5)ten thousand yuan vs.1.7(1.3-2.3)million were significantly higher than the ERCP group.Regarding longterm follow-up,3 cases(7.3%)of stones recurred in the LCBDE group and 14 cases(25%)in the ERCP group(p=0.024).There was 1 space-occupying lesion in the distal bile duct in the ERCP group(1.8%)and 1 bile duct stricture in the LCBDE group(2.4%).Conclusion:For patients with a history of common bile duct exploration,both LCBDE and ERCP are safe and feasible.LCBDE can achieve higher first stone clearance rate and lower stone recurrence rate,while ERCP has the advantages of convenient stone removal,quick postoperative recovery,and low cost.