Journal of Shandong University (Health Sciences) ›› 2022, Vol. 60 ›› Issue (5): 59-66.doi: 10.6040/j.issn.1671-7554.0.2021.1065

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Comparison among ERCP combined with ursodeoxycholic acid and other therapies in the treatment of choledocholithiasis complicated with cholecystolithiasis

DONG Xiaoqian1, LI Guanjiang1, XU Qianqian1, XU Hongwei1,2   

  1. 1. Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong, China;
    2. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
  • Published:2022-06-01

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Abstract: Objective To investigated the curative effects of endoscopic retrograde cholangiopancreatography(ERCP)combined with ursodeoxycholic acid(UDCA)and other two mainstream therapies in the treatment of patients over 75 with choledocholithiasis complicated with cholecystolithiasis, and to analyze factors affecting quality of life after surgery. Methods Clinical data of 184 elderly patients(≥75 years old)with choledocholithiasis and cholecystolithiasis treated in Shandong Provincial Hospital Affiliated to Shandong First Medical University during June 2017 and June 2019 were retrospectively analyzed. According to the treatment options, the patients were divided into ERCP+UDCA group with 66 patients, laparoscopic cholecystectomy(LC)+laparoscopic common bile duct exploration(LCBDE)group with 64 patients, and ERCP+LC group with 54 patients. The general data, short-term and long-term complications, and surgical condition were compared, and the quality of life was assessed with Gastrointestinal Quality of Life Index(GIQLI)scale two years after surgery. One-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data, and chi-square test or Fishers exact test was used for comparison of categorical data between groups. Bonferroni correction was used for multiple comparisons. Multinomial Logistic regression model was used to explore the independent factors of GIQLI scale two years after surgery. Results The three groups were comparable in age, sex, stone number and previous history(P>0.05). There were statistically significant differences among the ERCP+UDCA group, LC+LCBDE group and ERCP+LC group in operation time ［43.0(37.0, 61.8)min vs 200.0(170.0, 243.8)min vs 189.0(172.0, 215.5)min］, hospitalization costs ［31.9(27.1, 38.0)thousand yuan vs 45.8(38.1, 52.5)thousand yuan vs 54.4(48.6, 65.2)thousand yuan］, hospital stay ［6.0(5.0, 8.8)d vs 10.5(8.0, 12.0)d vs 13.0(9.0, 15.5)d］ and time to extraction of drainage tube ［3(2,4)d vs 30(28,30)d vs 4(4,7)d, all P<0.001］. Compared with the other two groups, the ERCP+UDCA group had shorter operation time, hospital stay and extraction of drainage tube, and lower hospital costs(all P<0.05). There were no significant differences in the rate of surgical success, postoperative catheterization, incidence of short-term and long-term complications, and GIQLI score among the three groups(all P>0.05). Age increase and postoperative complications were independent risk factors affecting GIQLI scale 2 years after surgery. Conclusion ERCP+UDCA could effectively control the disease without reducing elderly patients quality of life. Comprehensive therapy and individualized treatment based on the characteristics of the disease should be carried out in clinical treatment instead of performing the LC blindly. Early detection, early treatment and reduction of postoperative complications are effective ways to improve postoperative quality of life.

Key words: Choledocholithiasis, Cholecystolithiasis, Ursodeoxycholic acid, Elderly patients, Quality of Life

CLC Number: 

  • R657.42
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