A clinical study of three endoscopies combined with biliary stenting and primary closure of the common bile duct in treatment of choledocholithiasis

Abstract:

Objective：To investigate the clinical efficacy of three endoscopies combined with biliary stenting and primary closure of the common bile duct in the treatment of choledocholithiasis. Methods：A retrospective cohort study was performed on the clinical data of 380 patients with choledocholithiasis who were admitted to our hospital from January 2013 to January 2016. According to treatment methodology，126 patients were assigned to T-tube drainage group，124 patients to primary closure group，and 130 patients to three endoscopies combined with stenting group. The operation time，postoperative hospital stay，hospitalization cost，incidence of biliary complications，and postoperative liver function were compared between the three groups. Follow-up was regularly performed after surgery by outpatient clinic and telephone interview until January 2018. Results：①Treatment outcomes：there was no significant dif－ference in operation time between the T-tube drainage group，primary closure group，and three endoscopies combined with stenting group（106.66±5.01 vs. 105.52±5.62 vs. 105.50±6.10 min，P >0.05）. The T-tube drainage group and the primary closure group had significantly longer postoperative hospital stay and higher hospitalization cost than the three endoscopies combined with stenting group（7.91±0.83），（7.85±0.70） vs. （5.69±0.77） d，P <0.05；（22 081.43±687.55），（21 930.73±758.35） vs. （19 560.88±828.61） yuan，P<0.05. There was no significant difference in the incidence of bile leaking between the three groups（2 vs. 3 vs. 0 case，P >0.05）. In the three groups，liver function gradually re－covered within 5 to 7 days after surgery. The three endoscopies combined with stenting group and the T-tube drainage group showed similar recovery of liver function，which was significantly faster than that in the primary closure group（P <0.05）. ②Follow-up results：in the 380 patients，364 were followed up for 1 to 24 months. The median follow-up time was 20 months. Patients recovered well and no abdominal pain，jaundice，residual stones，or bile duct stricture was observed. Conclusion：Three endoscopies combined with biliary stenting and primary closure of the common bile duct is safe and feasible in the treatment of choledocholithiasis.