Abstract: Objective: To investigate the clinical effect of laparoscopic cholecystectomy ( LC) combind with endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic sphincterotomy ( EST) in sequential treament of extrahepatic lithiasis．. Methods: From January 2006 to December 2009, The clinical records of 420 consecutive patients suffered from extrahepatic lithiasis were reviewed. The clinical effects were received by followed up. Result: 398 of 420(94.7%) consecutive patients who suffered from common bile duct stones were performed by ERCP+EST successfully. 71 patients had the early complications such as hyperamylasemia,pancreatitis,the bleeding of the duodenum papilla. No patient had the complication of the perforation of intestine. After bile duct stone clearance, except of 57 patients whom had been treated by cholecystectomy,185 of 363 patients underwent LC. 5 patients were found residual stones in the common bile duct by the imaging checking and were cleared by the second step of the ERCP+EST. Follow-up data were available in 311 patients with 6-54 months.During a median follow-up period of 32 months.The rate of follow-up is 74.0%.16(5.1%) patients were found that had the recurrent stones in the common bile duct. Conclusion: It is a safe and effective method for treating patients with extrahepatic lithiasis by EST sequential with LC．

Key words: cholecystolithiasis, gallbladder stone, laparoscopic, duodenoscope, endoscopic sphincterotomy.

摘要： 目的：探讨ERCP(内窥镜逆行胆胰管造影术)+EST(内窥镜下括约肌切开术)[或和]LC(腹腔镜胆囊切除术)联合治疗肝外胆管结石的效果。方法：回顾性分析深圳市人民医院2006年-2009年间420例肝外胆管结石行ERCP+EST(或和)LC的患者资料，并进行随访。结果：420例患者中成功行ERCP+EST碎石取石者398例, 成功率94. 7%，术后并发高淀粉酶血症52例，胰腺炎8例, 十二指肠乳头出血11例，均经保守治疗后好转，未出现肠穿孔。57例患者既往已行胆囊切除，余363例患者中，185例行ERCP+EST取石术后序贯行LC，因胆囊三角粘连严重而中转开腹2例，5例LC后影像学复查提示胆总管残存结石，再次行ERCP取石。311例患者获得随访（6～54个月），中位随访时间32个月，随访率74.0%，16例复发，复发率为5.1%。结论：ERCP+EST(或和)LC联合治疗肝外胆管结石是目前较为安全和有效的方法，复发率少，临床应用价值高。

关键词: 胆总管结石, 胆囊结石, 腹腔镜, 十二指肠镜, 乳头括约肌切开