Propensity matching analysis of clinical efficacy of sequential therapy and emergency surgery for adult choledocholithiasis complicated by acute cholangitis

Du Zhi; He Zhan; Ni Desheng

doi:10.3969/j.issn.1002-1949.2024.09.012

Abstract：Objective To analyze the clinical efficacy of sequential therapy and emergency surgery in the treatment of adult choledocholithiasis complicated by acute cholangitis by using propensity matching analysis.Methods Clinical data of 90 adult patients with choledocholithiasis complicated by acute cholangitis admitted to Jinhua People's Hospital from September 2019 to July 2023 were collected.A total of 88 patients with complete follow-up data were finally included according to the inclusion and exclusion criteria,including 47 patients receiving sequential therapy(sequential group)and 41 patients receiving emergency surgical treatment(control group).Clinical data of the two groups were matched with 1:1 ratio,and perioperative indexes,complications,stone clearance,serum total bilirubin and alanine transaminase(ALT)levels of the two groups were further analyzed according to the matched data.Results The operative time of the sequential group was longer than that of the control group(min:95.12±14.51 vs.73.15±12.17),the abdominal drainage tube removal time(d:10.01±2.32 vs.13.34±2.15),biliary drainage tube removal time(d:25.41±5.06 vs.28.79±6.15),anal exhaust time(h:21.51±4.21 vs.25.29±3.19)and hospital stay time(d:12.21±3.38 vs.14.56±3.16)of the sequential group were shorter than those of the control group(P＜0.05),and the intraoperative blood loss of the sequential group was less than that of the control group(mL:26.14±8.05 vs.35.21±10.75,P＜0.05).The stone clearance rate of the sequential group was higher than that of the control group[88.89％(32/36)vs.69.44％(25/36),x2=4.126,P=0.042].The serum total bilirubin and ALT levels of the two groups were significantly decreased after the treatment compared with those at admission(P＜0.05),and the serum total bilirubin(μmol/L:32.33±5.95 vs.55.89±7.41)and ALT levels(U/L:45.76±7.16 vs.53.48±9.21)of the sequential group were lower than those of the control group(P＜0.05).Conclusions In the treatment of adult choledocholithiasis complicated by acute cholangitis,sequential therapy has better stone clearance,shorter hospital stay time,and less intraoperative blood loss.