[Comparison of three surgical patterns for cholecysto-choledocholithiasis]

Objective: To investigate the clinical efficiencies of the three surgical patterns in the treatment of cholecysto-choledocholithiasis (CCL). Methods: A total of 157 patients with CCL, during the period from Janury 2012 to Janury 2016 at the Affiliated Hospital of Inner Mongolia Medical University, were divided into three groups according to surgical patterns: LC-LCBDE Group (laparoscopic cholecystectomy+ laparoscopic common bile duct exploration, n=49), ERCP-LC Group (endoscopic retrograde cholangiopancreatography+ laparoscopic cholecystectomy, n=51) and OC-OCBDE Group (open cholecystectomy+ open common bile duct exploration, n=57). Simultaneously, the intraoperative, postoperative and follow-up results of all the patients were compared. Results: There were significantly differences among three groups in intraoperative blood loss[LC-LCBDE Group: (18.16±3.88) ml, ERCP-LC Group: (17.37±3.79) ml, and OC-OCBDE Group: (60.39±8.73) ml, P=0.000], operation time[LC-LCBDE Group: (118.27±8.89) min, ERCP-LC Group: (124.27±9.48) min, and OC-OCBDE Group: (94.25±6.39) min, P=0.000], surgical successful rate (LC-LCBDE Group 89.20%, ERCP-LC Group 86.93%, and OC-OCBDE Group 100%, P=0.02), intestine function recovery[LC-LCBDE Group (42.35±3.44) h, ERCP-LC Group (43.61±3.34) h, and OC-OCBDE Group (53.86±4.76) h, P=0.000], hospitalization cost[LC-LCBDE Group (18 600±1 300) yuan, ERCP-LC Group (33 300±2 000) yuan, and OC-OCBDE Group (13 800±1 900) yuan, P=0.000], serum amylase elevation (LC-LCBDE Group 1 case, ERCP-LC Group 14 cases, and OC-OCBDE Group 2 cases, P<0.01) and postoperative hospital stay (LC-LCBDE Group 5.20±0.77 d, ERCP-LC Group 4.85±0.51 d, and OC-OCBDE Group 8.55±0.71 d, P=0.000). There were no differences among three groups in postoperative biliary leakage (LC-LCBDE Group 2 cases, ERCP-LC Group 0 case, and OC-OCBDE Group 2 cases) and residual bile duct stone rate (LC-LCBDE Group 4.08%, ERCP-LC Group 5.88%, and OC-OCBDE Group 3.50%). Conclusion: All three types of surgical pattern are both efficacious and safe in the treatment of CCL. But no single pattern has absolute advantage over the other two. LC-LCBDE could preserve the function of Oddis sphincter, ERCP-LC could retain the integrity of common bile duct (CBD), and OC-OCBDE could serve as remedial measure for LC-LCBDE and ERCP-LC.