Retroscpective studies of different biliary drainage techniques in treatment of choledocholithiasis complicated with acute cholangitis

doi:10.16139/j.1007-9610.2025.03.08

Abstract

Abstract:

Objective To analyze the efficacy and safety of different minimally invasive operations[endoscopic re-trogradebiliary drainage(ERBD)、endoscopic nasobiliary drainage(ENBD)、percutaneous transhepatic cholangial drainage(PTCD)] for choledocholithiasis complicated with acute cholangitis to provide reference for clinical treatment retrospectively. Methods A total of 151 patients with choledocholithiasis complicated with acute cholangitis at Department of Emergency Surgery in our hospital from January 2019 to December 2020 were included and divided into four groups based on the four treatment strategies, including non-surgical treatment. Changes in leukocyte count, bilirubin levels, and liver function before and after treatment, as well as postoperative recovery, complication rates, length of hospital stay, and prognosis were compared among patients who underwent different surgical treatments. Results There were significant improvements in leukocyte count, percentage of neutrophils, and liver function of the patients underwent ENBD or ERBD operation (P<0.05). The total bilirubin and direct bilirubin were significantly reduced after ERBD, ENBD, and PTCD operations (P<0.05). Patients undergoing ERBD, ENBD, or PTCD demonstrated faster recovery times, fewer complications, shorter hospital stays, and lower mortality rates compared to those managed conservatively. Conclusions ERBD and ENBD as minimally invasive therapeutic modalities for the management of choledocholithiasis complicated with acute cholangitis, exhibit remarkable clinical efficacy, coupled with a high degree of safety and reliability. These techniques significantly enhance the long-term minimally invasive cure rate, thereby establishing them as the preferred treatment strategies. Tailored to the patient's specific clinical conditions, such as the severity of infection, stone dimensions, and the use of oral anticoagulant therapy, clinicians can formulate individualized minimally invasive treatment strategies, facilitating the optimal attainment of therapeutic objectives.

Key words: Choledocholithiasis, Acute cholangitis, Endoscopic retrogradebiliary drainage(ERBD), Endoscopic nasobiliary drainage(ENBD), Percutaneous transhepatic cholangial drainage(PTCD)

CLC Number:

SUI Liang, CHEN Sheng, LIU Yuanbin, HUANG Liang, MAO Enqiang, HAN Yi, SUN Silei, ZHANG Yong. Retroscpective studies of different biliary drainage techniques in treatment of choledocholithiasis complicated with acute cholangitis[J]. Journal of Surgery Concepts & Practice, 2025, 30(03): 228-233.

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References 14

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Item		Treatment				χ²/z/t value	P value
Item		Conservative(n=7)	PTCD(n=5)	ENBD(n=31)	ERBD(n=108)	χ²/z/t value	P value
Age（years）		78.4±9.9	75.6±11.9	72.1±12.6	69.4±13.5	1.528	0.210
Gender	Male	3（42.9）	2（40.0）	20（64.5）	66（61.1）	2.010	0.570
Gender	Female	4（57.1）	3（60.0）	11（35.5）	42（38.9）	2.010	0.570
Complications（case）	Diabetes	2（28.6）	1（20.0）	7（22.6）	20（18.5）	5.599	0.779
	Coronary heart disease	1（14.3）	0	5（16.1）	7（6.5）
	Hypertension	1（14.3）	3（60.0）	16（51.6）	46（42.6）
	Atrial fibrillation	0	0	3（9.7）	4（3.7）
Temperature（℃）		37.0±0.5	37.3±1.2	37.3±1.1	37.3±0.7	0.385	0.764
WBC(×10⁹/L)		9.0±3.8	12.9±4.3	10.2±3.9	12.6±6..0	2.274	0.082
N%（%）		78.6±20.3	89.3±3.1	85.8±8.1	87.1±8.5	2.070	0.107
TBil (μmol/L)		55.5±37.1	123.3±45.9	70.7±46.5	99.3±94,2	1.619	0.187
DBil (μmol/L)		29.4±22.4	79.9±27.9	39.9±28.7	65.1±111.6	0.848	0.47
ALT(IU/L)		153.7±95.4	193.0±145.1	264.5±212.3	342.7±247.8	2.502	0.062
AST(IU/L)		226.7±177.6	205.6±109.0	309.8±365.0	364.1±334.1	0.816	0.487
GGT(IU/L)		211.1±170.7	475.8±463.6	445.5±274.6	514.2±399.6	1.582	0.196
Severity degree	Ⅰ	1（14.3）	1（20.0）	4（12.9）	23（21.3）	3.966	0.681
	Ⅱ	4（57.1）	4（80.0）	19（61.3）	68（63.0）
	Ⅲ	2（28.6）	0（0.0）	8（25.8）	17（15.7）

Item	Treatment				χ² value	P value
Item	Conservative(n=7)	PTCD(n=5)	ENBD(n=31)	ERBD(n=108)	χ² value	P value
Hospitalization days	12.0±13.2	5.4±1.1	5.4±2.0	5.9±4.3	4.15	0.007
Fasting days	7.4±14.4	1.8±0.8	1.3±0.5	1.8±1.4	7.56	0.000

Item	Before or after treatment	Treatment
Item	Before or after treatment	Conservative(n=7)	PTCD(n=5)	ENBD(n=31)	ERBD(n=108)
WBC（×10⁹/L）	Before	9.0±3.8	12.9±4.3	10.2±3.9	12.6±6.0
	After	6.8±4.7	10.5±5.4	7.2±3.6	8.0±4.3
	t value	1.089	0.748	5.224	9.982
	P value	0.318	0.496	0.000	0.000
N%(%)	Before	78.6±20.3	89.3±3.1	85.8±8.1	87.1±8.5
	After	78.8±19.9	80. 8±10.4	71.9±11.5	74.9±11.0
	t value	-0.031	1.677	6.363	11.085
	P value	0.977	0.169	0.000	0.000
TBil(μmol/L)	Before	55.5±37.1	123.3±45.9	70.7±46.5	99.3±94.2
	After	57.0±45.3	64.1±38.2	41.8±30.9	58.0±80.5
	t value	-0.111	13.28	4.923	8.535
	P value	0.915	0.000	0.000	0.000
DBil(μmol/L)	Before	29.4±22.4	79.9±27.9	39.9±28.7	65.1±111.6
	After	31.9±28.7	30.4±22.8	19.4±19.9	26.7±40.4
	t value	-0.216	12.931	5.316	3.851
	P value	0.836	0.000	0.000	0.000
ALT(IU/L)	Before	153.7±95.4	193.0±145.1	264.5±212.3	342.7±247.8
	After	103.4±91.4	70.2±43.2	139.0±128.0	139.3±103.4
	t value	1.305	2.366	4.65	9.597
	P value	0.24	0.077	0.000	0.000
AST(IU/L)	Before	226.7±177.6	205.6±109.0	309.8±365.0	364.1±334.1
	After	93.7±95.2	51.0±44.9	91.8±105.0	73.7±76.4
	t value	1.691	3.611	4.323	9.029
	P value	0.142	0.023	0.000	0.000
GGT(IU/L)	Before	211.1±170.7	475.8±463.6	445.5±274.6	514.2±399.6
	After	163.3±118.1	163.3±118.1	313.9±190.2	332.3±2637
	t value	2.245	2.377	5.122	10.383
	P value	0.066	0.076	0.000	0.000

Item	Before or after treatment	Treatment
Item	Before or after treatment	ENBD(n=31)	ERBD(n=108)
Amylase (IU/L)	Before	70.4±74.4	115.7±165.8
	After	104.9±71.2	114.7±153.8
	t value	-1.809	0.037
	P value	0.088	0.971