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
[1] Moffatt DC, Yu BN, Yie W, et al. Trends in utilization of diagnostic and therapeutic ERCP and cholecystectomy over the past 25 years: a population-based study [J]. Gastrointestinal Endosc, 2014, 79(4): 615-622.
[2] European Association for the Study of the Liver(EASL). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones [J]. J Hepatol, 2016, 65(1): 146-181.
[3] 林秋满, 王桂良, 吴灶璇, 等. 一步法LCBDE+LC和序贯二步法ERCP/EST+LC治疗胆囊结石合并胆总管结石有效性及安全性的Meta分析 [J]. 中国全科医学, 2021, 24(14): 1805-1812. LIN Qiuman, WANG Guiliang, WU Zaoxuan, et al. Comparisin of efficacy and safety of one-stage LCBDE+LC and sequential two-stage ERCP/EST+LC in the treatment of cholecystolithiasis complicated with choledocholithiasis: a Meta-analysis [J]. Chinese General Practice, 2021, 24(14): 1805-1812.
[4] Mohamed MA, Bahram M, Ammar MS, et al. One-session laparoscopic management of combined common bile duct and gallbladder stones versus sequential ERCP followed by laparoscopic cholecystectomy [J]. J Laparoendosc Adv Surg Tech A, 2015, 25(6): 482-485.
[5] Kim Y, Lee E. The association between elderly peoples sedentary behaviors and their health-related quality of life: focusing on comparing the young-old and the old-old [J]. Health Qual Life Outcomes, 2019, 17(1): 131.
[6] 胡雪晴, 赵赟博, 张子瑾, 等. 75岁以上老年Ⅱ期结直肠癌根治术后患者复发因素分析[J]. 中华老年医学杂志, 2020, 39(5): 564-568. HU Xueqing, ZHAO Yunbo, ZHANG Zijin, et al. Analysis of factors for recurrence of stage Ⅱ colorectal cancer in patients aged 75 years and over after radical resection [J]. Chin J Geriatr, 2020, 39(5): 564-568.
[7] Wang HH, Portincasa P, Bari OD, et al. Prevention of cholesterol gallstones by inhibiting hepatic biosynthesis and intestinal absorption of cholesterol [J]. Eur J Clin Invest, 2013, 43(4): 413-426.
[8] May GR, Sutherland LR, Shaffer EA. Efficacy of bile acid therapy for gallstone dissolution: a meta-analysis of randomized trials [J]. Aliment Pharmacol Ther, 2010, 7(2): 139-148.
[9] Eypasch E, Williams JI, Wood-Dauphinee S, et al. Gastrointestinal Quality of Life Index: development, validation and application of a new instrument [J]. Br J Surg, 2010, 82(2): 216-222.
[10] Yeung SM, Shiu A, Martin CR, et al. Translation and validation of the Chinese version of the Gastrointestinal Quality of Life Index in patients with gastric tumor [J]. J Psychosom Res, 2006, 61(4): 469-477.
[11] Bansal VK, Misra MC, Rajan K, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial [J]. Surg Endosc, 2014, 28(3): 875-885.
[12] Zhou Y, Zha WZ, Wu XD, et al. Three modalities on management of choledocholithiasis: a prospective cohort study [J]. Int J Surg, 2017, 44: 269-273. doi: 10.1016/j.ijsu.2017.06.032.
[13] Ricci C, Pagano N, Taffurelli G, et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis [J]. JAMA Surg, 2018, 97(19): e181167. doi: 10.1001/jamasurg.2018.1167.
[14] Pan L, Chen M, Ji L, et al. The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: an up-to-date meta-analysis [J]. Ann Surg, 2018, 268(2): 247-253.
[15] Lyu Y, Cheng Y, Li T, et al. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis [J]. Surg Endosc, 2019, 33(10): 3275-3286.
[16] 林鸿坡. 胆总管结石大小对内镜腔镜联合与开腹手术治疗策略选择的影响[D]. 福州: 福建医科大学, 2017.
[17] 梁成刚, 冯春林, 梅永,等. ERCP和LCBDE治疗胆总管直径10~15 mm的肝外胆道结石疗效比较[J]. 齐齐哈尔医学院学报, 2020, 41(22): 2792-2796. LIANG Chenggang, FENG Chunlin, MEI Yong, et al. Comparison of efficacy of ERCP and LCBDE in the treatment of extrahepatic cholelithiasis with a common bile duct diameter of 10-15 mm [J]. Journal of Qiqihar Medical University, 2020, 41(22): 2792-2796.
[18] 李文晓, 李燕萍, 李秀军, 等. 胆总管结石内镜治疗的现代进展[J]. 中国医刊, 2020, 55(11): 1164-1168.
[19] Mohseni S, Ivarsson J, Ahl R, et al. Simultaneous common bile duct clearance and laparoscopic cholecystectomy: experience of a one-stage approach [J]. Eur J Trauma Emerg Surg, 2019, 45(2): 337-342.
[20] 依鸿魁, 荣大庆. LC联合术中ERCP同期治疗老年病人胆囊结石合并胆总管结石的临床研究[J]. 中国医疗器械信息, 2020, 26(8): 93-94. YI Hongkui, RONG Daqing. Clinical study of simultaneous ercp in lc combined with gallbladder stones and common bile duct stones in elderly patients [J]. China Medical Device Information, 2020, 26(8): 93-94.
[21] 胡益挺, 方哲平, 王爱东. ERCP联合LC治疗高龄胆囊结石合并胆总管结石临床经验[J]. 肝胆胰外科杂志, 2018, 30(6): 510-512.
[22] 杜前程, 周瀛, 张灵强,等. 结石性胆囊炎的个体化治疗[J]. 临床肝胆病杂志, 2018, 34(10): 2251-2256. DU Qiancheng, ZHOU Ying, ZHANG Lingqiang, et al. Individualized treatment of calculous cholecystitis [J]. Joural Clinical Hepatology, 2018, 34(10): 2251-2256.
[23] Sreyram K, Julie AS, Sanziana AR, et al. Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans [J]. Am J Surg, 2011, 201(6): 789-796.
[24] Mcalister VC, Davenport E, Renouf E. Cholecystectomy deferral in patients with endoscopic sphincterotomy [J]. Cochrane Database Syst Rev, 2007, 17(4): CD006233.doi:10.1002/14651858.CD006233.
[25] Chang HY, Wang CJ, Liu B, et al. Ursodeoxycholic acid combined with percutaneous transhepatic balloon dilation for management of gallstones after elimination of common bile duct stones [J]. World J Gastroenterol, 2018, 24(39): 4489-4498.
[26] Chen X, Yan XR, Zhang LP, et al. Ursodeoxycholic acid after common bile duct stones removal for prevention of recurrence: a systematic review and meta-analysis of randomized controlled trials [J]. Medicine, 2018, 97(45): e13086. doi: 10.1097/MD.0000000000013086.
[27] Kuy S, Sosa JA, Roman SA, et al. Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans [J]. Am J Surg, 2011, 201(6): 789-796.
[28] Holdsworth RJ, Sadek SA, Ambikar S, et al. Dynamics of bile flow through the human choledochal sphincter following exploration of the common bile duct [J]. World J Surg, 1989, 13(3): 300-304.
[29] Williams J, Treacy PJ, Sidey P, et al. Primary duct closure versus T-tube drainage following exploration of the common bile duct [J]. Aust N Z J Surg, 2010, 64(12): 823-826.
[30] Mattila A, Mrena J, Kellokumpu I. Cost-analysis and effectiveness of one-stage laparoscopic versus two-stage endolaparoscopic management of cholecystocholedocholithiasis: a retrospective cohort study [J]. BMC Surg, 2017, 17(1): 79.
[31] 印弘, 车素华, 魏经国, 等. 胆囊切除术后Oddi氏括约肌的功能评价 [J]. 实用放射学杂志, 1997, 13(8): 470-473. YIN Hong, CHE Suhua, WEI Jingguo, et al. The appreciation of sphincter of oddi motility post-cholecystectomy [J] Journal of Practical Radiology,1997, 13(8):470-473.
[32] Ng WW, Lai KH, Liu RS, et al. Biliary motility following endoscopic sphincterotomy for recurrent common bile duct stones [J]. Chin Med J, 1995, 56(3): 159-165.
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