探讨十二指肠镜联合腹腔镜治疗老年胆囊结石并肝外胆管结石的临床疗效。

回顾性分析2012年7月至2015年12月收治的108例老年胆囊结石并肝外胆管结石患者的临床资料，根据手术方式分为EST＋LC组(54例，采用十二指肠镜乳头括约肌切开术(EST)联合腹腔镜胆囊切除术(LC)治疗)和开腹＋引流组(54例，采用传统开腹胆囊切除术后，胆总管切开取石及T管引流术治疗)，采用SPSS17.0软件进行统计学分析，手术效果相关指标及术后恢复指标等以(±s)表示，采用独立t检验；术后并发症发生率、患者满意率等组间比较采用χ²检验，P<0.05为差异有统计学意义。

EST＋LC组患者手术时间、切口长度、术中出血量、术后胃肠功能恢复时间、术后下床活动时间以及平均住院时间均明显低于开腹＋引流组(均P<0.05)；EST＋LC组患者术后并发症发生率明显低于开腹＋引流组，远期疗效优于开腹＋引流组，差异均有统计学意义(P<0.05)。

十二指肠镜联合腹腔镜微创治疗老年胆囊结石并肝外胆管结石是安全可行的，能够取得良好的临床疗效。

To investigate the clinical efficacy of combination use of duodenoscopy and laparoscopy for elderly patients with gallbladder stones and concomitant extrahepatic bile duct stones.

The clinical data of 108 elderly patients with gallbladder stones and concomitant extrahepatic bile duct stones admitted to our hospital from July 2012 to December 2015 were analyzed retrospectively. According to the surgical procedures , all the cases were divided into EST+ LC group (54 cases received endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC)) and Laparotomy anddrainage group (54 cases received the traditional open cholecystectomy, common bile duct lithotomy and T tube drainage). Statistical analysis was performed by using SPSS17.0 software, operation effect indicators and post-operative recovery indicators were expressed as (±s) and were compared by student's t test, post-operative complication rate, satisfaction rate were compared by chi-square test. P<0.05 was considered as significant difference.

The operation time, length of incision, blood loss, post-operative gastrointestinal function restoration time, ground activity time and the average hospitalization time in EST+ LC group were significantly better than those in Laparotomy and drainage group, there were statistically significant differences between the two groups (P<0.05); the post-operative complication rate in EST+ LC group was significantly lower than that in Laparotomy and drainage group, and the long-term effect was better than that in Laparotomy and drainage group, there were statistically significant differences between the two groups (P<0.05).

Combination use of duodenoscopy and laparoscopy for elderly patients with gallbladder stones and concomitant extrahepatic bile duct stones is a safety and feasible procedure which could achieve good clinical efficacy.