Comparison of Laparoscopic Two-step Method and One-step Method in the Treatment of Elderly Patients with Gallbladder Stones and Common Bile Duct Stones

Li Gaoju; Niu Jianguang

doi:10.3969/j.issn.1004-5775.2025.02.003

Abstract：Objective:To compare the efficacy of laparoscopic two-step and laparoscopic one-step treatment for elderly patients with gallbladder stones and common bile duct stones.Methods:A total of 100 elderly patients with gallbladder stones and common bile duct stones who were admitted in Xiangcheng Traditional Chinese Medicine Hospital in Henan Province from January 2022 to January 2023 were selected,and they were divided into the one-step group(57 cases)and the two-step group(43 cases)with different surgical methods.The one-step group was treated with endoscopy combined with abdominal endoscopy one-step method(exploration and removal of common bile duct stones+cholecystectomy),and the two-step method group was treated with endoscopy combined with laparoscopic two-step method(endoscopic retrograde cholangiopancreatography+cholecystectomy).The perioperative indicators,stone removal status,inflammatory indicators and complications were compared between the two groups.Results:Compared with the two-step method group,the one-step method group had longer operation time,shorter bowel sound recovery time,postoperative exhaust time and hospital stay,and less hospitalization cost,with statistically significant difference(t=3.571,2.835,2.199,5.274,2.688;P＜0.05).There was no significant difference in stone residual rate and stone recurrence rate between the two groups(χ2=0.105,0.002;P＞0.05).1 d after surgery,the levels of NEUT and CRP in the one-step group were lower than those in the two-step group,and the difference was statistically significant(t=4.609,3.069;P＜0.05).The incidence of complications in the one-step group was lower than that in the two-step group,and the difference was statistically significant(χ2=4.456,P＜0.05).Conclusion:Both endoscopic combined with laparoscopic two-step method and laparoscopic one-step method can achieve good stone removal results in elderly patients with gallbladder stones and common bile duct stones.The one-step method has a longer surgical time,but can promote faster postoperative recovery,reduce fluctuations in inflammatory indicators,and reduce the incidence of complications.