Comparison of efficacy between one-stage LCBDE+LC and two-stage ERCP+LC for choledocholithiasis complicated with cholecystolithiasis without common bile duct dilatation

doi:10.3877/cma.j.issn.2095-3232.2025.03.014

Abstract

Abstract:

Objective

To compare clinical efficacy between one-stage laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy （LCBDE+LC） and two-stage endoscopic retrograde cholangiopancreatography combined with LC （ERCP+LC） for choledocholithiasis complicated with cholecystolithiasis without common bile duct dilatation （6-10 mm in diameter）.

Methods

Clinical data of 104 patients with choledocholithiasis and cholecystolithiasis admitted to Jiangyin People’s Hospital from January 2017 to December 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them， 44 patients were male and 60 female， aged from 21 to 78 years， with a median age of 48 years. All patients were divided into the LCBDE+LC （n=56） and ERCP+LC groups （n=48） according to surgical methods. The operative and postoperative condition between two groups were compared by Chi-square test or t test.

Results

The success rate of stone removal in the LCBDE+LC group was 98%（55/56）， significantly higher than 85%（41/48） in the ERCP+LC group （P＜0.05）. The incidence of postoperative complications was 12.5%（7/56）and 12.5%（6/58） in two groups， and the difference was not statistically significant （χ²=2.270， P=0.132）. In the LCBDE+LC group， 4 patients developed grade A bile leakage， 2 cases of incisional infection and 1 case of surgical site hematoma， who were cured after conservative treatment. In the ERCP+LC group， 1 case had bleeding after ERCP， 1 case of acute pancreatitis and 1 case of incisional infection， who were healed after conservative treatment. 2 cases of duodenal perforation were treated with open repair of duodenal perforation and peritoneal lavage and drainage. 1 of them was recovered after treatment and the other case died of multiple organ failure at postoperative 2 weeks. In the LCBDE+LC group， the length of postoperative hospital stay was （5.6±2.4） d， significantly shorter than （10.3±2.5） d in the ERCP+LC group （t=13.560， P＜0.05）. In the LCBDE+LC group， hospitalization expense was （2.3±1.1）×10⁴ Yuan， significantly less than （3.5±0.9）×10⁴ Yuan in the ERCP+LC group （t=8.443， P＜0.05）. In the LCBDE+LC group， the score of satisfaction at postoperative 6 weeks was （2.3±0.3）， significantly higher than （1.9±0.7） in the ERCP+LC group （t=5.252，P＜0.05）. During 1-year follow-up， no bile duct stenosis was found， 2 cases of bile reflux， 1 case of cholangitis and 1 case of stone recurrence were found in the LCBDE+LC group. In the ERCP+LC group，3 cases developed bile reflux， 2 cases of cholangitis and 2 cases of stone recurrence.

Conclusions

Compared with ERCP+LC， LCBDE+LC yields higher success rate of stone removal， shorter length of hospital stay， less hospitalization expense and higher degree of satisfaction in the treatment of choledocholithiasis complicated with cholecystolithiasis without common bile duct dilatation. However， the incidence of complications and long-term efficacy is similar between two groups.

Key words: Common bile duct stones, Gallstones, Laparoscopic common bile duct exploration, Endoscopic retrograde cholangiopancreatography (ERCP), Laparoscopic cholecystectomy (LC), No dilated common bile duct

Wenzhu Jiang, Jingchao Jia, Biao Zhou, Xiaowei He, Zhicheng Deng. Comparison of efficacy between one-stage LCBDE+LC and two-stage ERCP+LC for choledocholithiasis complicated with cholecystolithiasis without common bile duct dilatation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(03): 423-429.

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Figures/Tables 2

指标	LCBDE+LC组	ERCP+LC组	统计值	P值
年龄（岁， $\overset{ˉ}{x}$ ± s ）	55±11	55±10	t=0.131	0.890
性别（例，男/女）	23/33	21/27	χ ²=0.076	0.782
胆管炎（例）	9	6	χ ²=0.267	0.605
胰腺炎（例）	1	2	-	0.594
WBC（×10⁹， $\overset{ˉ}{x}$ ± s ）	8.1±1.8	8.3±2.0	t=0.743	0.458
TB（μmol/L， $\overset{ˉ}{x}$ ± s ）	46±4	45±6	t=1.465	0.145
ALP（U/L， $\overset{ˉ}{x}$ ± s ）	677±122	643±128	t=1.913	0.057
ALT（U/L， $\overset{ˉ}{x}$ ± s ）	152±24	148±22	t=1.317	0.189
Scr（μmol/L， $\overset{ˉ}{x}$ ± s ）	72±17	74±22	t=0.474	0.636
ALB（g/L， $\overset{ˉ}{x}$ ± s ）	37±6	38±6	t=1.042	0.299
胆总管直径（mm， $\overset{ˉ}{x}$ ± s ）	7.2±2.6	7.3±2.9	t=0.184	0.854
胆总管结石数目［个， M ( Q₁,　 Q₃ )］	1（1，2）	1（1，2）	Z=-0.720	0.472

指标	LCBDE+LC组	ERCP+LC组	统计值	P值
年龄（岁， $\overset{ˉ}{x}$ ± s ）	55±11	55±10	t=0.131	0.890
性别（例，男/女）	23/33	21/27	χ ²=0.076	0.782
胆管炎（例）	9	6	χ ²=0.267	0.605
胰腺炎（例）	1	2	-	0.594
WBC（×10⁹， $\overset{ˉ}{x}$ ± s ）	8.1±1.8	8.3±2.0	t=0.743	0.458
TB（μmol/L， $\overset{ˉ}{x}$ ± s ）	46±4	45±6	t=1.465	0.145
ALP（U/L， $\overset{ˉ}{x}$ ± s ）	677±122	643±128	t=1.913	0.057
ALT（U/L， $\overset{ˉ}{x}$ ± s ）	152±24	148±22	t=1.317	0.189
Scr（μmol/L， $\overset{ˉ}{x}$ ± s ）	72±17	74±22	t=0.474	0.636
ALB（g/L， $\overset{ˉ}{x}$ ± s ）	37±6	38±6	t=1.042	0.299
胆总管直径（mm， $\overset{ˉ}{x}$ ± s ）	7.2±2.6	7.3±2.9	t=0.184	0.854
胆总管结石数目［个， M ( Q₁,　 Q₃ )］	1（1，2）	1（1，2）	Z=-0.720	0.472

指标	LCBDE+LC组	ERCP+LC组	统计值	P值
取石成功（例）	55	41	-	0.023
中转开腹（例）	0	1	-	0.460
结石残留（例）	1	6	-	0.023
经胆囊管切开取石（例）	2	-
手术时间（min， $\overset{ˉ}{x}$ ± s ）	99±15	96±16	t=0.981	0.329
术中失血量（ml， $\overset{ˉ}{x}$ ± s ）	39±4	40±4	t=1.271	0.207
术后24 h疼痛评分（分， $\overset{ˉ}{x}$ ± s ）	5.6±1.8	5.0±1.7	t=1.616	0.107
满意度评分（分， $\overset{ˉ}{x}$ ± s ）	2.3±0.3	1.9±0.7	t=5.252	＜0.001
术后并发症（例）	7	6	χ ²=2.270	0.132
出血	1	1	-	＞0.999
A级胆漏	4	0	-	0.122
胰腺炎	0	1	-	0.461
伤口感染	2	1	-	＞0.999
穿孔	0	2	-	0.498
住院死亡	0	1	-	＞0.999
住院时间（d， $\overset{ˉ}{x}$ ± s ）	5.6±2.4	10.3±2.5	t=13.560	＜0.001
住院费用（万元， $\overset{ˉ}{x}$ ± s ）	2.3±1.1	3.5±0.9	t=8.443	＜0.001
胆汁反流（例）^a	2	3	-	0.657
结石复发（例）^a	1	2	-	0.594
胆管炎（例）^a	1	2	-	0.594

指标	LCBDE+LC组	ERCP+LC组	统计值	P值
取石成功（例）	55	41	-	0.023
中转开腹（例）	0	1	-	0.460
结石残留（例）	1	6	-	0.023
经胆囊管切开取石（例）	2	-
手术时间（min， $\overset{ˉ}{x}$ ± s ）	99±15	96±16	t=0.981	0.329
术中失血量（ml， $\overset{ˉ}{x}$ ± s ）	39±4	40±4	t=1.271	0.207
术后24 h疼痛评分（分， $\overset{ˉ}{x}$ ± s ）	5.6±1.8	5.0±1.7	t=1.616	0.107
满意度评分（分， $\overset{ˉ}{x}$ ± s ）	2.3±0.3	1.9±0.7	t=5.252	＜0.001
术后并发症（例）	7	6	χ ²=2.270	0.132
出血	1	1	-	＞0.999
A级胆漏	4	0	-	0.122
胰腺炎	0	1	-	0.461
伤口感染	2	1	-	＞0.999
穿孔	0	2	-	0.498
住院死亡	0	1	-	＞0.999
住院时间（d， $\overset{ˉ}{x}$ ± s ）	5.6±2.4	10.3±2.5	t=13.560	＜0.001
住院费用（万元， $\overset{ˉ}{x}$ ± s ）	2.3±1.1	3.5±0.9	t=8.443	＜0.001
胆汁反流（例）^a	2	3	-	0.657
结石复发（例）^a	1	2	-	0.594
胆管炎（例）^a	1	2	-	0.594

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