Efficacy of LCBDE+LC on Patients with Cholecystolithiasis and Common Bile Duct Stone and its Influence on Postoperative Complications

Guo Xueliang; Wang Xiangzheng; Zhang Huilai

doi:10.3969/j.issn.1004-5775.2024.24.007

Abstract：Objective:To observe the efficacy of laparoscopic common bile duct exploration+laparoscopic cholecystectomy(LCBDE+LC)in the treatment of patients with cholecystolithiasis complicated with common bile duct stone(CBDS)and its influence on postoperative complications,and to provide evidence-based medical reference for clinical treatment.Methods:68 patients with CBDS in department of hepatobiliary surgery of the hospital from January 2019 to January 2023 were included in the study,and they were divided into two groups according to different surgical methods.Among the patients,34 cases who underwent LCBDE+LC were selected as LCBDE+LC group,and 34 cases who underwent endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy(EST)+LC were classified as ERCP/EST+LC group.The differences in perioperative indicators and incidence rates of postoperative complications were compared between the two groups.The inflammatory response[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),substance P(P)]and immune function(CD4+,CD8+,CD4+/CD8+)were recorded and compared between both groups 1 day before surgery and 3 days after surgery.Results:The operative time,intraoperative blood loss,postoperative exhaust time,bile drainage time,bed time and hospital stay in LCBDE+LC group were significantly lower than those in ERCP/EST+LC group,and the total stone clearance rate was significantly higher than that in ERCP/EST+LC group.The difference was statistically significant(t=2.314,4.623,3.198,2.225,2.214,4.012;x2=4.221;P＜0.05).At 3 days after surgery,the levels of IL-6,TNF-α and P in the two groups were significantly increased,but the levels of CD4+,CD8+and CD4+/CD8+in the LCBDE+LC group were lower than those in the ERCP/EST+LC group,and the levels of CD4+and CD8+were significantly decreased in the two groups.The total incidence of postoperative complications in LCBDE+LC group and ERCP/EST+LC group was 14.71％and 20.59％,respectively,with no significant difference(x2=0.405,P＞0.05).Conclusion:LCBDE+LC treatment of patients with cholecystolithiasis complicated with CBDS can better remove stone,with less trauna and better recovery.It can reduce inflammation of patients.