探讨在腹腔镜下采用经胆囊管手术路径行胆总管探查取石的可行性、安全性。

回顾性分析2020年11月至2024年10月54例胆总管结石合并胆囊结石患者临床资料，其中男性30例，女性24例，年龄（66.9±9.7）岁。根据手术方式不同分为两组，行吲哚菁绿（ICG）荧光腹腔镜经胆囊管行胆管探查取石（LTCBDE）术24例为观察组，行ICG荧光腹腔镜胆总管切开取石术（LCBDE）30例为对照组。比较两组患者胆囊管、肝总管、胆总管三管识别时间、胆管探查及取石时间、手术时间、术中出血量；手术成功率、结石清除率、术后住院时间、住院费用、并发症情况等指标。采用SPSS 26.0统计学软件分析数据。正态分布的计量资料以（±s）表示，两组间比较行独立样本t检验。计数资料以[例(%)]表示，两组间比较采用χ²检验或Fisher确切概率法。P<0.05为差异有统计学意义。

两组患者手术均成功实施，三管识别时间、术中出血量、手术成功率比较差异无统计学意义（均P>0.05）；而观察组患者胆管探查及取石时间、手术时间均较对照组短，差异有统计学意义（均P<0.05）。两组患者手术并发症发生率、住院总治疗费用比较差异无统计学意义（P>0.05）,但患者术后住院时间及负压引流管带管的时间差异有统计学意义（均P<0.05）。

对于部分胆囊结石合并胆总管结石或者具备胆总管探查指征的患者，经胆囊管行胆总管探查、取石是一种安全可行的外科手术方式，从而避免行胆总管切开，且可以避免术后带T管影响患者的生活质量，减少术后住院时间及负压引流管带管时间，值得在临床推广开展。

To explore the feasibility and safety of performing common bile duct exploration and stone removal through the cystic duct surgical approach under laparoscopy.

The clinical data of 54 patients with common bile duct stones and gallbladder stones from November 2020 to October 2024 were retrospectively analyzed. Among them, 30 were male and 24 were female, with an average age of (66.9±9.7) years. The patients were divided into two groups based on different surgical methods: 24 cases underwent indocyanine green (ICG) fluorescence laparoscopic cystic duct common bile duct exploration and stone removal (LTCBDE), and 30 cases underwent ICG fluorescence laparoscopic common bile duct incision and stone removal (LCBDE). The comparison included the time for identifying the cystic duct, common bile duct, and common duct, the time for common bile duct exploration and stone removal, the operation time, intraoperative blood loss; the success rate of the operation, stone clearance rate, postoperative hospital stay, hospitalization cost, and complications. Data were analyzed using SPSS 26.0 statistical software. Quantitative data with normal distribution were expressed as (±s), and comparisons between the two groups were performed using independent sample t tests. Count data were expressed as [cases (%)], and comparisons were conducted using the χ² test or Fisher’s exact probability method. P<0.05 was considered statistically significant.

Both groups successfully underwent the surgery. There were no statistically significant differences in the time for identifying the cystic duct, intraoperative blood loss, and operation success rate between the two groups (all P>0.05); however, the observation group had shorter time for common bile duct exploration and stone removal, and shorter operation time compared with the control group (all P<0.05). There was no statistically significant difference in the incidence of surgical complications and total hospitalization cost between the two groups (P>0.05), but there were statistically significant differences in the postoperative hospital stay and the duration of negative pressure drainage tube placement (all P<0.05).

For patients with gallbladder stones and common bile duct stones or those with indications for common bile duct exploration, performing common bile duct exploration and stone removal through the cystic duct is a safe and feasible surgical method, which avoids common bile duct incision and can avoid the impact of T-tube placement on the patient’s quality of life after surgery, reduces the postoperative hospital stay and the duration of negative pressure drainage tube placement, and is worthy of clinical promotion and implementation.