Effect of ERCP and LCBDE on acute severe cholangitis secondary to choledocholithiasis

doi:10.3877/cma.j.issn.1674-3946.2025.01.017.

Abstract

Abstract:

Objective

To explore the efficacy of endoscopic retrograde cholangiopancreatography（ERCP） and laparoscopic choledocholithotomy （LCBDE） in the treatment of acute severe cholangitis （ACST）secondary to choledocholithiasis.

Methods

The clinical data of one hundred and twenty patients with ACST secondary to CBDS who received surgical treatment were retrospectively analyzed from January 2022 to January 2024.AccorThe clinical data of 120 patients with ACST secondary to choledocholithiasis who underwent surgical treatment from January 2022 to January 2024 were retrospectively analyzed.According to different surgical methods， patients receiving ERCP treatment were assigned to the ERCP group （n=68 cases） and those receiving LCBDE treatment were assigned to the LCBDE group （n=52 cases）.SPSS 26.0 was used for data processing.Measurement data such as perioperative indicators were expressed as （x± s）， and independent sample t test was performed.The incidence of complications and other statistical data were χ² test.Test level α=0.05.

Results

The amount of intraoperative blood loss in ERCP group was lower than that in LCBDE group， and the operation time， activity recovery time， first exhaust time and hospital stay were shorter than that in LCBDE group（P＜0.05）.There was no significant difference in stone removal rate between ERCP group and LCBDE group（98.5% vs.96.2%， P＞0.05）.The liver and bile biochemical indexes of serum total bilirubin （TBIL）， alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in ERCP group and LCBDE group were lower than those before surgery （P＜0.05）， but there was no statistical significance between the two groups （P＞0.05）.The inflammatory markers of white blood cell count （WBC）， neutrophil count （ANC） and serum high mobility group protein B1 （HMGB1） in 2 groups were lower than those before surgery （P＜0.05）， and ERCP group was significantly lower than LCBDE group （P＜0.05）.The overall complication rate in the ERCP group was lower than that in the LCBDE group （1.5% vs.11.5%）（P＜0.05）.

Conclusion

ERCP is more effective than LCBDE in the treatment of ACST secondary to choledocholithiasis.This procedure can significantly improve the surgical and postoperative recovery indicators of patients， promote the rapid recovery of liver and gallbladder and inflammation， and the risk of complications is small， so it can be used as the first choice in clinical treatment of ACST secondary to choledocholithiasis.

Key words: Secondary Acute Severe Cholangitis, Cholangiopancreatography, Endoscopic Retrograde, Laparoscopic Common Bile Duct Exploration

Bo Li, Pengbo Jia, Dong Li, Xiaoqing Li. Effect of ERCP and LCBDE on acute severe cholangitis secondary to choledocholithiasis[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 60-63.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2025.01.017.

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2025/V19/I01/60

Figures/Tables 5

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ±s）	性别（例）男/女	合并疾病（例）A/B/C/D	ASA分级（例）Ⅰ/Ⅱ/Ⅲ
ERCP组	68	58.6±7.4	42/26	5/9/31/23	18/37/13
LCBDE组	52	59.7±7.3	37/15	3/7/22/20	13/31/8
t/χ²/Z值		0.812	1.155	0.361	0.400
P		0.419	0.283	0.948	0.819

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ±s）	性别（例）男/女	合并疾病（例）A/B/C/D	ASA分级（例）Ⅰ/Ⅱ/Ⅲ
ERCP组	68	58.6±7.4	42/26	5/9/31/23	18/37/13
LCBDE组	52	59.7±7.3	37/15	3/7/22/20	13/31/8
t/χ²/Z值		0.812	1.155	0.361	0.400
P		0.419	0.283	0.948	0.819

组别	例数	术中出血量（ml）	手术时间（min）	活动恢复时间（h）	首次排气时间（h）	住院时间（d）
ERCP组	68	25.7±7.0	91.4±20.0	15.1±3.8	16.2±4.8	7.2±2.1
LCBDE组	52	60.3±12.6	123.7±22.5	18.0±5.0	19.1±6.9	9.1±2.9
t/χ²值		19.126	8.303	3.611	2.713	4.163
P值		＜0.001	＜0.001	＜0.001	0.008	＜0.001

组别	例数	时间	TBIL（μmol/L）	ALT（U/L）	AST（U/L）
ERCP组	68	术前	142.3±35.5	183.6±36.5	151.4±35.7
ERCP组	68	术后	110.8±26.3^a	68.3±19.4^a	76.0±23.7^a
LCBDE组	52	术前	141.4±36.5	185.5±36.7	155.5±35.6
LCBDE组	52	术后	113.6±29.4^a	70.1±19.3^a	81.7±23.3^a

组别	例	时间	WBC（×10⁹/L）	ANC（%）	HMGB1（μg/L）
ERCP组	68	术前	28.2±3.7	81.6±3.3	17.8±3.2
ERCP组	68	术后	13.2±2.1^ab	65.7±6.1^ab	5.5±1.1^ab
LCBDE组	52	术前	28.1±3.8	82.2±4.2	17.9±3.3
LCBDE组	52	术后	14.5±2.2^a	69.5±6.0^a	6.7±2.0^a

组别	例数	感染	出血	恶心呕吐	总并发症
ERCP组	68	0（0.0）	0（0.0）	1（1.5）	1（1.5）
LCBDE组	52	1（1.9）	1（1.9）	4（7.7）	6（11.5）
χ²值		-	-	-	5.347
P值		-	-	-	0.020

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