Objective: Laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic sphincterotomy (EST) combined with LC are the two primary treatment modalities for common bile duct stones (CCL) at present. The aim of this study is to compare the efficacy and safety of the two surgical approaches in treating CCL and analyze the risk factors for the recurrence of common bile duct stones.
Methods: The clinical data of 148 CCL patients treated in the hospital from March 2014 to March 2016 were retrospectively analyzed. ERCP+LC was performed for 74 patients (ERCP+LC group), while the remaining 74 patients underwent LC+LCBDE (LC+LCBDE group). The success rate of lithotomy, operation time, total hospital stay time, postoperative hospital stay time, clinical symptoms, incidence rate of complications, and hospitalization expenses were compared between the two groups. The patients were followed up, the recurrence of choledocholithiasis was recorded, and the risk factors for recurrence were analyzed.
Results: The success rate of lithotomy was 97.3% in the LC+LCBDE group and 94.6% in the ERCP+LC group. In the ERCP+LC group and LC+LCBDE group, the average operation time was (125.7±20.3) min and (106.5±25.4) min, the postoperative anal ventilation time was (20.8±3.5) d and (18.7±3.7) d, and the postoperative hospital stay time was (9.3±3.1) d and (7.7±3.3) d, respectively. It can be seen that the above three indexes were all significantly shorter in the LC+LCBDE group than those in ERCP+LC group (P < .001, P < .001, P = .003). The hospitalization expenses in the LC+LCBDE group [(19±1) thousand yuan] were obviously lower than those in the ERCP+LC group [(26±2) thousand yuan] (P < .001). The postoperative symptoms included fever, vomiting, abdominal pain and abdominal distension. The incidence rate of abdominal pain in the LC+LCBDE group was far higher than that in the ERCP+LC group (P = .025), and that of the remaining symptoms had no statistically significant difference between the two groups (P > .05). The postoperative complications mainly included incision infection, bile duct bleeding, biliary fistula, abdominal infection, bile duct pneumatosis, cholangitis and acute pancreatitis. Hyperamylasemia occurred in 8 cases after operation in the ERCP+LC group, greatly more than that in the LC+LCBDE group (1 case) (P = .016), while the incidence of other complications had no statistically significant difference between the two groups (P > .05). The patients were followed up for 3-5 years, and it was found that the recurrence rate of choledocholithiasis was 17.6% and 13.5%, and the mean postoperative recurrence time was 13.7 months and 13.9 months, respectively, in ERCP+LC group and LC+LCBDE group. The results of multivariable logistic regression analysis revealed that the level of cholesterol >572 mm/L (OR=5.108, 95%CI: 1.263-11.472, P = .038), choledochectasia (OR=2.165, 95%CI: 1.019-8.418, P = .034) and parapapillary diverticulum (OR=6.761, 95%CI: 1.334-15.613, P = .039) were independent risk factors for postoperative recurrence of choledocholithiasis.
Conclusions: In our study, we found that ERCP+LC and LC+LCBDE have definite efficacy in the treatment of CCL. Patients treated with LC+LCBDE need short hospital stay time and low treatment expenses and have relatively few long-term complications.