【摘要】 目的:探讨腹腔镜联合胆道镜治疗胆囊结石合并胆囊管结石的手术方法及临床经验。方法:回顾分析2018年5月至2021年3月收治的17例胆囊结石合并胆囊管结石患者的临床资料，分析腹腔镜联合胆道镜手术的方法、术中难点及处理经验。结果:本组17例手术均顺利完成，无中转开腹及胆管损伤发生，术后患者均顺利康复。14例(82.4%)采用常规三孔法、3例(17.6%)采用四孔法施术。处理胆囊三角：常规入路14例(82.4%),壶腹入路3例(17.6%)。处理胆囊管结石：以腔外游离为主，腔内探查为辅，纵行切开取石。患者均完成腹腔镜联合胆道镜探查胆囊管并取石，其中1例(5.9%)行胆道镜下网篮取石。处理胆囊管残端：常规夹闭12例(70.6%),线扎2例(11.8%),缝扎1例(5.9%),2例(11.8%)于胆囊管汇入部微切开取石后用6-0可吸收线缝合切开部，再以Hem-o-lok夹闭残端。本组完整切除胆囊8例(47.1%),部分切除9例(52.9%)。9例(52.9%)放置腹腔引流管，72 h后拔除。结论:腹腔镜联合胆道镜治疗胆囊结石合并胆囊管结石安全、有效，术中根据患者情况采取相应处理可保障手术的安全。更多还原

【Abstract】 Objective:To explore the surgical method of laparoscopy combined with choledochoscopy in the treatment of gallstones with cystic duct stones, and summarize the clinical experience.Methods:The clinical data of 17 patients with gallstones and cystic duct stones treated from May 2018 to Mar.2021 were retrospectively analyzed, and the surgical methods, intraoperative difficulties and treatment experience of laparoscopy combined with choledochoscopy were analyzed.Results:All the 17 operations were successfully completed without conversion to laparotomy or bile duct injury, and all the patients uneventfully recovered after surgery.There were 14 cases(82.4%) of conventional three-port technique and 3 cases(17.6%) of four-port method.In the treatment of the Calot triangle, there were 14 cases(82.4%) with conventional approach and 3 cases(17.6%) with ampullary approach.In the treatment of cystic duct stones, the main method was extraluminal dissociation, which was supplemented by intraluminal exploration, and the bile duct was longitudinally cut to remove stones.All cystic duct stones were explored and removed by laparoscopy combined with choledochoscopy.Among them, 1 case(5.9%) took out the stone using choledochoscopic basket.In the treatment of cystic duct remnant, there were 12 cases of conventional clipping(70.5%),2 cases of ligation with thread(11.8%),1 case of suture(5.9%),after microincision and stone removal at the confluence of cystic duct in another 2 cases(11.8%),the incision was sutured with 6-0 absorbable thread, and the stump was clamped with Hem-o-lok.Complete cholecystectomy was performed in 8 cases(47.1%) and partial cholecystectomy in 9 cases(52.9%).Drainage tubes were placed in the abdominal cavity in 9 cases(52.9%) and removed 72 h later.Conclusions:Laparoscopy combined with choledochoscopy is a safe and effective method for the treatment of gallstones with cystic duct stones.The use of corresponding skills according to the situation of patients can ensure the safety of operation.更多还原