Abstract: Objective To compare the clinical efficacy of three minimally invasive surgical approaches for gallstones and common bile duct,which are laparoscopic common bile duct exploration （LCBDE）+primary closure （PS）+laparoscopic cholecystectomy （LC）,laparoscopic common bile duct exploration+T-tube drainage （TD）+laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography （ERCP）+laparoscopic cholecystectomy. Methods Collect clinical data of 229 patients who underwent surgery for common bile duct stones at Peking University Shenzhen Hospital from July 2012 to July 2017, and compare and analyze the three minimally invasive treatments before surgery. Evaluation of the differences in postoperative and hospitalization time and cost between the three surgical methods. Results The three groups of patients were： age, gender, preoperative ALT, preoperative TBil, common bile duct diameter, number of common bile duct stones, and bile The difference in the maximum diameter of the common stones was not statistically significant （P>0.05）; there was no statistical difference in the incidence of postoperative TBil, postoperative analgesia, and postoperative complications among the three groups. Significance （P>0.05）; ERCP+LC group has shorter operation time than LCBDE+PS+LC group and LCBDE+TD+LC group. There is less bleeding during surgery. Postoperative abdominal drainage time and postoperative antibiotic use time are shorter, but the transition High rate, long postoperative fasting time, and slow recovery of ALT; LCBDE+PS+LC group has shorter postoperative hospital stay than ERCP+LC group and LCBDE+TD+LC group; hospitalization costs between the three groups ERCP+LC group> LCBDE+TD+LC group> LCBDE+PS+LC group. Conclusion The ERCP + LC group has the advantages of shorter operation time, less bleeding during the operation, shorter postoperative abdominal drainage time, and shorter antibiotic use time. Disadvantages of long postoperative fasting time： LCBDE+PS+LC group recovers faster than LCBDE+TD+LC group after surgery, with less impact on quality of life, and the incidence of complications does not increase significantly.

Key words: laparoscopic common bile duct exploration, endoscopic retrograde cholangiopancreatography, primary suture, T-tube drainage, gallbladder stones combined with common bile duct stones, laparoscopic cholecystectomy

摘要： 目的 比较腹腔镜胆总管探查（LCBDE）+一期缝合（PS）+腹腔镜胆囊切除术（LC）、腹腔镜胆总管探查+T管引流术（TD）+腹腔镜胆囊切除术和经内镜逆行胰胆管造影（ERCP）+腹腔镜胆囊切除术三种微创手术方式治疗胆囊结石合并胆总管结石的临床疗效。方法 收集2012年7月至2017年7月于北京大学深圳医院因胆总管结石行手术治疗的229例患者的临床资料,对比分析三种微创治疗方式的术前、术中、术后及住院时间及费用情况的差异评价三种手术方式之间差异。结果 三组患者在年龄、性别、术前ALT、术前TBil、胆总管直径、胆总管结石个数和胆总管结石最大直径的差异不具有统计学意义（P>0.05）;三组间术后TBIL、术后镇痛、术后并发症发生率差异无统计学意义（P>0.05）;ERCP+LC组较LCBDE+PS组和LCBDE+TD组手术时间短、术中出血量少、术后腹腔引流时间及术后抗生素使用时间短,但中转率高、术后禁食时间长、ALT恢复慢;LCBDE+PS组较ERCP+LC组和LCBDE+TD组术后住院时间短;三组间的住院费用ERCP+LC组>LCBDE+TD组>LCBDE+PS组。结论 ERCP+LC组具有手术时间短、术中出血少、术后腹腔引流时间和使用抗生素时间短的优点,也存在手术中转率较高、术后禁食时间长的缺点。LCBDE+PS组较LCBDE+TD组术后恢复快,生活质量影响小,且并发症发生率未见明显增多。

关键词: 一期缝合术, 经内镜逆行胰胆管造影, 胆囊结石合并胆总管结石, 腹腔镜胆总管探查术, T管引流术, 腹腔镜胆囊切除术