Comparative Study on Laparoscopic Common Bile Duct Exploration and Endoscopic Retrograde Cannulation of Pancreatic in Treatment of Acute Mild to Moderate Cholangitis
FENG Jie,LIANG Huan,LIU Jian-zhong
Chengde Medical College, Chengde (067000), China
Abstract:
Objective To investigate the ef.cacy of laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cannulation of pancreatic (ERCP) in the treatment of acute mild and moderate cholangitis caused by calculi. Methods The medical records of 111 patients with calculous acute mild to moderate cholangitis admitted to Cangzhou People’s Hospital from January 2017 to December 2018 were retrospectively analyzed. The patients were divided into two groups according to the surgical methods, such as double-mirror group (n=41) and endoscopy group (n=70). Laparoscopy combined with choledochoscopic common bile duct exploration and lithotripsy was performed in the double-mirror group.ERCP, endoscopic sphincterotomy (EST), endoscopic papillary balloon dilation (EPBD), basket or balloon lithotripsy were performed in the endoscopic group. The operation time, hospitalization time, hospitalization expenses, postoperative exhaust time, incidence of complications (LCBDE complications including bile leakage, incision infection, biliary tract hemorrhage, ERCP complications including transient amylase elevation, pancreatitis, biliary tract hemorrhage, etc.), rate of one-time stone clearance rate, and recurrence in 6 months after operation were recorded. The difference of therapeutic effect between the two kinds of operation was compared by statistical analysis. Results The operation was successful in both groups. There was no case of conversion to open surgery in double-mirror group. One case in endoscopy group was converted to open surgery due to severe bleeding of the biliary tract. The operation time of double-mirror group was (103.20±35.80) min, and that of the endoscopy group was (105.60±29.88) min. There was no signi.cant difference in the operation time between the two groups (P>0.05). The hospitalization time was (12.78±2.73) d and (11.36±2.65) d, the difference was statistically signi.cant (P<0.05), and the endoscopy group was shorter in hospitalization time. The hospitalization expenses of the double-mirror group and endoscopy group were (2.64±0.45) ten thousand Yuan and (3.15±0.62) ten thousand Yuan, respectively. There was a statistically signi.cant difference(P<0.05), and the double-mirror group had less hospitalization costs. The postoperative exhaust time of the two groups was (2.35±0.85)d and (3.24±0.90)d, respectively. The difference between the two groups was statistically signi.cant (P<0.05). The exhaust time of the double-mirror group was faster. The rate of one-time stone removal was 100% in double-mirror group and 94.3% in endoscopy group, and the rate of postoperative complications was 2.0% in double-mirror group and 8.5% in endoscopy group. The recurrence rate of stones in 6 months after surgery was 0 in double-mirror group and 1.4% in endoscopy group. There was no significant difference in the comparison between the two groups (P>0.05). Conclusion LCBDE can reduce the cost of hospitalization and shorten the exhaust time after treatment of calculus in patients with acute mild to moderate cholangitis. ERCP can shorten the length of hospital stay. Clinically, the corresponding procedure should be selected according to the actual situation.
