Comparison of efficacy between endoscopic and laparoscopic treatment for elderly patients with multiple extrahepatic bile duct stones after cholecystectomy
Comparison of efficacy between endoscopic and laparoscopic treatment for elderly patients with multiple extrahepatic bile duct stones after cholecystectomy
Objective To compare the efficacy and safety between endoscopic retrograde cholangiopancreatography(ERCP)and laparoscopic common bile duct exploration(LCBDE)in treatment of elderly patients with multiple extrahepatic bile duct stones after cholecystectomy.Methods The clinical data of elderly patients with multiple extrahepatic bile duct stones after cholecystectomy admitted to the Department of General Surgery of Shanghai Xuhui District Central Hospital from July 2019 to October 2022 were retrospectively analyzed.Among 52 patients,23 cases received LCBDE(LCBDE group)and 29 cases received ERCP(ERCP group),and the efficacy and surgery-related complications of two groups were compared.Results There were no significant differences between the two groups in terms of gender,age,and having comorbid diabetes.The maximum diameter of stones and the diameter of the common bile duct in the LCBDE group were significantly larger than those in the ERCP group[(13.78±2.52)mm vs(9.38±2.82)mm and(14.96±2.50)mm vs(10.86±2.75)mm,all P＜0.05].There was no perioperative death in either group.In the LCBDE group,grade A bile leak occurred postoperatively in 1 case,and stone residue occurred in 2 cases,which was treated by choledochoscopy 2 months after surgery.In the ERCP group hyperamylasemia occurred in 3 cases and grade B pancreatitis occurred in 1 case.The operative time,anal exhaust time and length of postoperative hospital stay in LCBDE group were significantly longer than those in ERCP group[(123.74±26.14)min vs(24.86±5.55)min,(62.60±15.71)h vs(24.72±6.46)h and(9.40±1.44d)vs(3.55±1.84)d,respectively;all P＜0.05].There were no significant differences in preoperative biochemical parameters between two groups(P＞0.05).The WBC count at the first postoperative day,the CRP levels at the first and third postoperative days in the LCBDE group were significantly higher than those in the ERCP group[(12.29±2.64)×109/L vs(10.11±2.91)×109/L,(51.96±14.70)mg/L vs(36.17±14.04)mg/L and(23.30±8.20)mg/L vs(15.10±5.85)mg/L;all P＜0.05].Conclusion In elderly patients with multiple extrahepatic bile duct stones after cholecystectomy,treatment with both LCBDE and ERCP are safe and effective;however,the ERCP has a shorter operative time and a better and faster postoperative recovery,which is the preferred treatment option for smaller bile duct stones.
关键词
内镜逆行胰胆管造影/腹腔镜胆总管探查术/胆囊切除术/肝外胆管结石/腹腔镜手术
Key words
endoscopic retrograde cholangiopancreatography/laparoscopic common bile duct exploration/laparoscopic cholecystectomy/extrahepatic bile duct stones/laparoscopic surgery
维普
万方数据