壶腹周围病变超声内镜诊断价值的探讨

目的 探讨超声内镜（EUS）对壶腹周围病变的诊断价值。方法 对56例壶腹周围病变患（肿瘤性病变44例，非肿瘤性病变12例）施行超声内镜检查，并与体外超声（US），CT检查比较。结果 对照手术结果，EUS对肿瘤性病变正确诊断率为88.6%(39/44)，漏诊3例，误诊2你；非肿瘤性病变正确诊断率83.4%(10/12)，误诊2例。EUS对全部病例的诊断符合率为87.5%(49/56)。US与CT分别为53.6%(30/56）与46.4%(26/56)。有显差异（P=0.011)。结论 EUS是诊断壶腹周围病变的良好手段，特别是对小病变有显的优越性。     

EUS和ERCP、MRCP在可疑胆总管结石诊断中的临床价值

目的：评价内镜超声检查（EUS）,内窥镜逆行胆胰管造影（ERCP）和磁共振成像胆胰管造影（MRCP）在诊断可疑胆总管结石的临床价值。 方法：自2009年6月至2010年3月我院收治的胆总管结石可疑病例共93例。93例病例全部经内镜超声检查（EUS）,内窥镜逆行胆胰管造影（ERCP）和磁共振成像胆胰管造影（MRCP）方法进行诊断,前瞻性研究三项诊断方法的临床诊断价值。 结果：联合两种以上诊断方法,可大幅提高胆总管患者的诊断准确率。EUS对胆总管结石检出的灵敏性为83.8%,特异性73.7%;ERCP对胆总管结石检出的灵敏性为89.2%,特异性84.2%;MRCP对胆总管结石敏感性为93.2%,特异性100%。 结论：MRCP无论在胆总管结石可疑患者检出的特异性或灵敏性上,都显著高于另EUS和ERCP方法,显示MRCP在诊断胆总管结石可疑患者具有较大的临床优势。胆总管结石可疑患者首先可行MRCP筛查,阴性者可进一步实施ERCP或EUS检查确认。     

超声内镜对胰胆管扩张病因的诊断价值

目的 探讨超声内镜对胰胆管扩张病因的诊断价值。方法 对25例体外超声（US）检查发现有肝外胆管胰管扩张,但病因诊断有困难的患者施行超声内镜（EUS）、CT、MRI检查,并比较各种检查法的诊断效能。病种包括壶腹周围肿瘤19例,胆总管下段嵌顿性结石3例和其他病变3例。结果 与手术后病理对比,US、EUS、CT、MRI的病变检出率依次为17．4％（4／23）、82．6％（19／23）、21．7％（5／23）和26．7％（4／15）,对19例肿瘤的检出率分别为10．5％（2／19）、84．2％（16／19）、15．7％（3／19）、23．1％（3／13）,EUS对肿瘤定位的符合率为87．5％（14／16）。与其他影像学检查相比,肿瘤越小EUS的优势越大。对3例结石US均未能确诊,EUS3例全部检出并确诊,CT检出2例,MRI在2例中检出1例。结论 EUS是诊断胰胆管扩张病因、鉴别病变性质、确定肿瘤起源的敏感检查方法,但对小于1cm的乳头癌和胆管癌的诊断可有一定的困难。     

内镜超声检查在腹腔镜胆囊切除术前的价值

目的评估内镜超声检查(EUS)对于胆囊结石患者在行腹腔镜胆囊切除术(LC)术前排除胆总管下段良性疾病的价值。方法回顾性分析我院从2004年1月至2008年1月患有胆囊结石并行LC的住院病历资料共1000例,选取常规B超(BUS)提示胆总管直径≥0.7cm病例共202例,分为EUS组和BUS组,计算EUS组的诊断率、敏感度、特异度,BUS组的胆总管下段良性病变的漏诊率。结果 EUS的对胆总管良性疾病的敏感度和特异度分别为98.2%、92.5%,阳性预测价值阴性预测价值分别为94.7%、92.5.4%,术前正确诊断率为95.8%;BUS组对胆总管结石的术前漏诊率为55.7%(21/46),对所有胆总管下段良性疾病的漏诊率为65.2%(30/46);所有EUS组患者未发生严重并发症。结论胆囊结石患者当术前B超提示胆总管直径≥7mm时,胆总管结石或者下段良性病变的比例为65.2%,其中大部分为胆总管结石,EUS对胆总管下段良性疾病诊断的敏感度、特异度、阳性预测价值、阴性预测价值和正确诊断率均高于90%,因此EUS可以作为胆总管良性扩张的诊断筛查方法。     

消化道类癌内镜治疗方法的比较

目的 比较内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）、内镜下黏膜切除术（endoscopic mucosal resection,EMR）和深凿活检钳除术治疗消化道类癌的效果.方法 回顾性分析我院2007年1月-2012年12月经病理确诊的49例消化道类癌的临床资料,结合超声内镜检查表现,比较ESD（n=25）、EMR（n=16）和内镜深凿活检钳除（n=8）治疗消化道类癌的组织学完全切除率、并发症及内镜随访情况.结果 内镜治疗消化道类癌的组织学完全切除率为59 2%（29/49）.ESD组的组织完全切除率76.0%（19/25）明显高于EMR组43.8%（7/16）和深凿活检钳除组37.5%（3/8）,差异有统计学意义（P=0.048）,其中ESD组组织完全切除率明显高于EMR组（χ^2=4.374,P=0.036）.直径≥1 cm的11例类癌中,4例（36.4%）组织学不完全切除.组织学不完全切除的20例中,仅3例术前进行了超声内镜检查,占超声内镜检查的15.0%（3/20）;组织学完全切除的29例中,17例进行了超声内镜检查,占超声内镜检查85.0%（17/20）.1例ESD治疗后发生出血,其余患者未出现并发症.22例（44.9%,22/49）随访1-23个月（平均10.4月）,均未复发.结论与EMR相比,ESD在组织完全切除方面更具有优势.超声内镜检查对于术前评估具有重要意义.     

胰腺分裂症5例诊治分析

目的 分析胰腺分裂症（pancreas divisum,PD）的临床特点,探讨PD的诊治方法。方法 回顾性分析绍兴市人民医院2010年8月至2018年5月收治的5例PD患者资料,主要指标包括临床表现、影像学检查及治疗方法。结果 5例PD患者均以反复发作的上腹痛为主要临床表现,其中急性复发性胰腺炎病史3例,慢性胰腺炎急性发作史1例,仅表现为慢性胰源性腹痛1例。5例患者均行内镜下逆行性胰胆管造影（endoscopic retrograde cholangiopancreatography,ERCP）确诊,超声内镜（endoscopic ultrasonography,EUS）检出率100%（3/3）,CT检出率20%（1/5）,MRCP检出率25%（1/4）。1例患者经保守治疗,4例患者经内镜下副乳头扩张术、副乳头切开术及胰管支架置入术治疗,症状均得到有效缓解。结论 PD患者的主要症状是反复发作性上腹痛,ERCP是PD诊断的“金标准”,EUS是PD诊断非常有效的临床手段,内镜下治疗是PD最主要治疗手段。     

超声内镜诊断胆总管小结石的临床研究

目的:探讨超声内镜检查术(EUS)对于胆总管小结石的诊断率及临床价值。方法:回顾性分析行EUS检查患者159例,所有病人结合病史及临床体征考虑为胆总管结石,但影像学检查未发现结石。EUS发现胆总管结石者随即行ERCP取石术;ERCP失败者行手术取石。EUS未发现胆总管结石者,则不行ERCP,但随访至少三个月。结果 :159例患者中EUS发现结石者96例;89例ERCP取石成功,1例ERCP失败者手术取出结石,1例排石,5例为假阳性。63例EUS未发现结石者随访三个月未发现结石。无操作相关并发症发生。超声内镜诊断胆总管小结石的准确性、敏感性、特异性、阳性和阴性预测值分别为96.8%、100%、92.6%、94.8%和100%。结论:超声内镜诊断胆总管小结石安全、可靠。     

内镜超声检查术的规范化操作及应用进展

一、内镜超声检查术（endoscopic ultrasonography,EUS）的适应证1.EUS的诊断适应证：（1）消化道肿瘤的TNM分期;也就是说,所有确诊或疑似的消化道肿瘤都应行EUS。（2）消化道隆起性病灶的诊断。（3）肝门部胆管疾病。有研究表明,对于诊断不明的肝门部胆管疾病,     

胰岛素瘤5例诊治体会

目的:提高对胰岛素瘤的认识、诊断和治疗,同时评价内镜超声(EUS)在胰岛素瘤术前定位诊断中的临床价值.方法:对5例疑为胰岛素瘤的患者的临床资料和定位诊断进行总结分析.术前均行内镜超声、腹部超声以及计算机断层扫描检查,同时与手术中的发现及手术后的病理结果相对比.结果:4例住院期间发生低血糖,3例有典型Whipple三联征,1例饥饿试验诱发.术前EUS、CT(平扫+增强)、US检查,检出率分别为83.3%(5/6)、33.3%(2/6)16.7%(1/6);,5例全部手术,手术共发现6个病灶,4例为腺瘤,1例为增生.而与手术后病理结果比较,EUS对胰岛素瘤的诊断符效率为80.0%(4/5),对胰腺病灶的部位以及大小的诊断均基本与手术发现相符.结论:胰岛素瘤常反复发作低血糖,有各种交感神经兴奋及神经精神症状,影像学以EUS对胰腺占位病灶的术前定位诊断优于传统的影像学检查,且创伤小,是一种临床可行且较有价值的检查方法.     

超声内镜对胰腺癌的诊断与治疗进展

随着超声内镜仪的普及,内镜超声检查术(endoscopic ultrasonography,EUS)已成为诊断胰腺疾病的首选方法,尤其是EUS引导下FNA技术的应用极大地提高了胰腺肿瘤的诊断准确率,新型超声内镜仪及三维微型高频超声探头的应用提高了小胰癌的显示率.EUS已经历了3个重要阶段,即EUS诊断(EUS imaging);EUS穿刺活检(EUS-guided FNA);EUS注射治疗(EUS-guided fine needle injection,FNI),现在已进入介入性EUS(interveiltional EUS)时代.     

"Sequential" treatment: is it the best alternative in cholecysto-choledochal lithiasis?

Laparoscopic cholecystectomy has become the treatment of choice for patients with symptomatic cholelithiasis. About 10-20% of patients with gallbladder stones may also present associated common bile duct stones. The management of the latter remains controversial because many different surgical strategies are available: laparoscopic treatment (laparoscopic common bile duct exploration), sequential endoscopic and laparoscopic treatment (endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy [ERCP/ES] prior to laparoscopic cholecystectomy), inverted sequential endoscopic-laparoscopic treatment (laparoscopic cholecystectomy followed by ERCP/ES), and combined endoscopic-laparoscopic treatment (laparoscopic cholecystectomy with intraoperative ERCP/ES). The aim of this study was to evaluate the efficacy and safety of sequential endoscopic-laparoscopic treatment in patients with cholecystocholedocholithiasis. We retrospectively analyzed the clinical, biochemical and radiological features of 552 patients operated on for cholelithiasis from 1991 to 2001. Common bile duct stones were suspected on the basis of increased serum levels of bilirubin, GOT, GPT, GGT, alkaline phosphatase; presence of jaundice; history of pancreatitis or cholangitis; dilated common bile duct (diameter > 8 mm) or common bile duct stones at hepatobiliary ultrasonography; presence of common bile duct stones at MR-cholangiography or at i.v. cholangiography. In patients with suspected common bile duct stones, preoperative ERCP was performed; if common bile duct stones were confirmed, ES was performed. When common bile duct stones were not suspected preoperatively, laparoscopic cholecystectomy was performed directly. Overall morbidity, mortality and conversion rates in the two groups were evaluated. Of 552 patients admitted for cholelithiasis, 62 (11.3%) underwent preoperative ERCP for suspected common bile duct stones. In 41 patients (66.1%) common bile duct stones were identified and ES with common bile duct stone extraction was performed in 40 patients (clearance: 97.5%). The overall morbidity was 16% (10 cases of post-ERCP acute pancreatitis); no mortality occurred. The conversion rate during subsequent laparoscopic cholecystectomy was 4.8%. In the group of patients with no suspicion of common bile duct stones, the conversion rate was 4.9%. Sequential treatment cannot be considered the best approach for patients with cholecystocholedocholithiasis because of its morbidity rate and the high rate of negative preoperative ERCP findings. Combined endoscopic-laparoscopic treatment seems to present more advantages, especially in term of morbidity, hospital stay and patient compliance and may, in future, be considered the treatment of choice for patients with cholecystocholedocholithiasis.     

LC+LCBDE+PDC与ERCP+EST+LC治疗胆囊结石合并胆总管结石的对比研究

目的 探讨腹腔镜胆囊切除术联合胆总管探查一期缝合（LC+LCBDE+PDC）与内镜下胆管取石联合腹腔镜胆囊切除术（ERCP+EST+LC）两种手术方式治疗胆囊结石合并胆总管结石的疗效比较。方法 回顾性分析2017 年5月至2019 年5月郑州大学附属郑州中心医院135 例胆囊结合并胆总管结石的患者临床资料,76例行LC+LCBDE+PDC（PDC组）,59例行ERCP+EST+LC（ERCP组）,比较两组手术时间、术中出血量、术后疼痛、术后禁食时间、术后活动时间以及术后住院时间、住院费用和并发症情况。结果 术前两组患者在年龄、性别、体重指数、胆总管直径、最大结石直径及数量、血清胆红素水平方面均无统计学差异（P＞0.05）。PDC组在术中出血量[（39.0±18.6）mL vs （59.5±21.3）mL,t=3.574,P=0.038]、术后禁食时间[（42.8±12.9）h vs（72.8±23.9）h,t=4.443,P=0.014]、下床活动时间[（18.7±3.2）h vs（32.6±8.2）h,t=1.553,P=0.017]、术后住院时间[（5.21±1.29）d vs（8.79±2.37）d,t=2.265,P=0.023]和住院费用[（25 187±1 179）元 vs（38 406±1 315）元,t=5.374,P=0.008]方面均优于ERCP组（P＜0.05）,在手术时间、术后疼痛方面两组均无统计学差异（P＞0.05）。两组在术后出血、黄疸方面均无统计学差异（P＞0.05）,PDC组在术后胃肠道反应[11.8%（9/76）vs 25.4%（15/59）,χ2 =4.191,P=0.041]、胰腺炎[2.6%（2/76）vs 13.6%（8/59）,χ2 =4.299,P=0.038]、残余结石[0（0/76）vs 6.8%（4/59）,χ2 =5.310,P=0.034]发生率方面低于ERCP组,但胆漏发生率[7.9%（6/76）vs 0（0/59）,χ2 =4.875,P=0.035]高于ERCP组,差异有统计学意义（P＜0.05）。结论 LC+LCBDE+PDC治疗胆囊结石合并胆总管结石安全有效,既能避免术后留置T管,也能保留Oddi括约肌功能,值得临床推广应用。     

胆囊结石合并胆总管结石术后复发的危险因素分析

目的：探讨内镜手术治疗胆囊结石合并胆总管结石患者复发的相关影响因素。 方法：回顾性分析2010年1月—2012年12月应用内镜治疗胆囊结石合并胆总管结石99例患者（51例行腹腔镜下胆囊切除+胆总管切开取石术，48例行腹腔镜下胆囊切除+十二指肠镜乳头切开取石术）的临床与随访资料，对影响结石复发的相关因素行单因素与多因素分析。 结果：术后共19例患者复发，复发率为19.19%。单因素分析显示，术后结石复发与年龄、黄疸、胆管扩张、胆总管直径、结石最大直径、结石数目、胆管、胰腺炎症以及手术类型等因素有关（均P<0.05），Logistic多因素回归分析发现，年龄（OR=2.692，P=0.011）、胆总管直径（OR=2.249，P=0.022）、结石数量（OR=2.647，P=0.017）、结石最大直径（OR=2.348，P=0.009）、合并炎症（OR=2.801，P=0.013）、手术类型（OR=2.421，P=0.018）是结石复发的独立危险因素。 结论：内镜手术治疗胆囊结石合并胆总管结石术后结石复发受多种因素影响，应当根据具体情况采用有针对性措施降低复发率。     

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??Value of endoscopic ultrasonography to prevent retained calculus in common bile duct post-laparoscopic cholecystectomy CHEN Liu-hua*, WU Zhi-mian, ZHENG Chao-xu, et al. *Department of Minimal Invasive Surgery, the First Affiliated Hospital of SUN Yat-sen University, Guangzhou 510080, China Corresponding author??CHEN Liu-hua, E-mail??chlh22@163.com Abstract Objective To evaluate the rate of final diagnosis of common bile duct (CBD) stones pre-laparoscopic cholecystectomy (LC) and to decrease retained calculus in CBD post-LC. Methods From January 2004 to July 2007, 100 symptomatic gallstones patients performed endoscopic ultrasonography (EUS) for suspected choledocholithiasis pre-LC at the First Affiliated Hospital of Sun Yat-sen University. The EUS results were analyzed. Results The successful rate of EUS were 100%. Occult CBDS were found in 54 patients . The sensitivities, specificities, accuracies, positive and negative predictive values for occult CBDS by EUS were 96.30%??97.83%??97.00%??98.11% and 95.74%. Conclusion EUS is necessary for patients to decrease the rate of retained calculus in CBD post-LC.     

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??Evaluation of magnetic resonance cholangiopancreatography and endoscopic ultrasonography in the diagnosis of suspected choledocholithiasis LI Chun-fei*??ZHAO Hai-ying??TIAN Zhong. *Department of General Surgery??Shengjing Hospital of China Medical University??Shenyang 110004??China
Corresponding author??TIAN Zhong??E-mail: tianz@sj-hospital.org
Abstract Objective To evaluate the clinical value of magnetic resonance cholangiopancretography and endoscopic ultrasonography in the diagnosis of suspected choledocholithiasis. Methods The clinical data were collected from 111 patients who were suspected with choledocholithiasis but not confirmed by transabdominal ultrasound and CT from July 2013 to July 2015 in Department of General Surgery??Shengjing Hospital of China Medical University.The result of MRCP and EUS were evaluated and compared. Results Compared with MRCP??EUS had obvious advantages in the sensitivity(89.2% vs. 75.7%, P??0.05)??but no obvious difference in the specificity or accuracy??P??0.05??. For the distal bile duct stones and those diamter no more than 0.5cm, the positive predictive value of EUS was higher than that of MRCP ??P??0.05??. The sensitivity of EUS combined with MRCP was 95.95%. Conclusion In the diagnosis of choedocholithiasis??EUS is better than MRCP??especially for the microlith at the end of biliary.MRCP has better bile duct structure imaging.For those complicated suspected cases, EUS combined with MRCP could reduce the missed diagnosis rate furtherly.     

内镜超声及磁共振胰胆管造影对可疑肝外胆管结石的诊断价值分析

目的 评估内镜超声（EUS）及磁共振胰胆管造影（MRCP）在可疑肝外胆管结石中的诊断价值。方法　选取中国医科大学附属盛京医院术前腹部超声及CT均未能确诊的肝外胆管结石病人111例,对其EUS及MRCP诊断结果进行对比分析。结果 EUS对胆管结石的敏感度（89.2%）高于MRCP（75.7%）（P＜0.05）,而特异度及准确率二者相比差异无统计学意义（P＞0.05）。EUS对胆管末端及直径≤0.5 cm的胆管结石阳性预测值（82.14%）亦高于MRCP,差异具有统计学意义（P＜0.05）。两种检查手段联合应用敏感度为95.95%。结论 EUS对胆管结石诊断更有优势,对胆管末端结石敏感度较高;MRCP对胆道树成像良好,可提供客观影像以辅助手术治疗,对胆道结构紊乱的病例价值更高;对其他影像检查诊断不清的疑似病例,两种检查联合应用可进一步降低漏诊率。     

The efficacy of preoperative endoscopic retrograde cholangiopancreatography in the detection and clearance of choledocholithiasis.

BACKGROUND AND OBJECTIVES: Endoscopic retrograde cholangiopancreaticography has been reported to have a high success rate in the detection and treatment of choledocholithiasis. Although there is growing enthusiasm for laparoscopic common bile duct clearance, many patients who present with gallbladder disease and suspected choledocholithiasis have endoscopic retrograde cholangiopancreatography performed with choledocholithiasis cleared if detected. These patients are then referred for laparoscopic cholecystectomy. The purpose of this study is to determine the efficacy of preoperative endoscopic retrograde cholangiopancreatography in the diagnosis and clearance of bile duct stones at our institution. METHODS: A retrospective review was performed of all patients at this institution who underwent preoperative endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis followed by laparoscopic cholecystectomy from January 1997 through July 1998. RESULTS: Common bile duct stones were detected endoscopically in 12 of 17 (71%) patients. We found serum bilirubin level to be the best predictor of choledocholithiasis. In 12 of 12 procedures, the endoscopist performed an endoscopic sphincterotomy with stone extraction and reported a fully cleared common bile duct. Intraoperative cholangiogram performed during subsequent cholecystectomy revealed choledocholithiasis in 4 of these 12 patients. Laparoscopic techniques successfully cleared the choledocholithiasis in 3 of these patients with open techniques necessary in the fourth. CONCLUSIONS: Our data suggests that even after presumed successful endoscopic clearance of the bile duct stones, many patients (33% in our series) still have choledocholithiasis present at the time of cholecystectomy. We recommend intraoperative cholangiography at the time of cholecystectomy even after presumed successful endoscopic retrograde cholangiopancreatography with further intervention, preferably laparoscopic, to clear the choledocholithiasis as deemed necessary.     

Single-Stage vs. Two-Stage Management for Concomitant Gallstones and Common Bile Duct stones: A Prospective Randomized Trial with Long-Term Follow-up

Aim

The preferred approach to the management of common bile duct (CBD) stones is uncertain, with single-stage laparoscopic cholecystectomy and CBD exploration vs. two-stage preoperative endoscopic CBD clearance followed by laparoscopic cholecystectomy being debated. To address this, a prospective randomized study which compared these two management strategies was undertaken.

Methods

Between Jan 2002 and Dec 2005, patients with gallstones and common bile duct stones diagnosed by preoperative ultrasonography and magnetic resonance cholangiopancreatography were randomized to single-stage vs. two-stage treatment. In a single-stage group, laparoscopic cholecystectomy and CBD exploration were undertaken at the same operation, whereas in a two-stage group, endoscopic stone clearance was followed by laparoscopic cholecystectomy 2–5 days later. Early treatment success and complications and longer-term follow-up for the two groups were compared.

Results

Two hundred twenty-one patients were enrolled in the trial, 110 in the single-stage group and 111 in the two-stage group. There was no significant difference in the success rate of CBD clearance (93.6 vs. 94.6 %, p?=?0.76) or the complication rates (3.6 vs. 5.1 %, p?=?0.527) between the groups. However, at longer-term follow-up, recurrent CBD stones were seen more often in the two-stage group (9.5 vs. 2.1 %, p?=?0.037).

Conclusion

The single-stage and two-stage approaches were equally effective in achieving initial clearance of CBD stones. However, recurrent CBD stones occurred more commonly in patients who had undergone two-stage treatment with initial endoscopic stone clearance, followed by laparoscopic cholecystectomy.     

腹腔镜手术治疗胆囊结石合并胆总管结石术后结石复发危险因素的meta分析

目的:采用meta分析的方法系统评价腹腔镜手术治疗胆囊结石合并胆总管结石术后复发的相关危险因素。方法:计算机检索PubMed、Cochrane Library、Embase、中国生物医学文献数据库、中国知网、维普、万方等数据库,收集截至2019年10月公开发表的研究腹腔镜治疗胆囊结石合并胆总管取石术后结石复发危险因素的相关文章,采用RevMan 5.3软件进行meta分析。结果:共纳入12项研究、1 658例患者。meta分析结果显示,复发组中有碎石手术史患者的比例高于未复发组(OR=4.41,95%CI=2.63~7.38,P<0.01);复发组中合并胆管炎、胰腺炎患者的比例高于未复发组(OR=3.40,95%CI=2.25~5.13,P<0.01);复发组中合并胆囊管扩张患者的比例高于未复发组(OR=4.08,95%CI=2.81~5.93,P<0.01);复发组中合并胆总管扩张患者的比例高于未复发组(OR=4.12,95%CI=2.96~5.75,P<0.01);复发组中合并胆总管直径>1.0 cm患者的比例高于未复发组(OR=4.96,95%CI=3.59~6.86,P<0.01);腹腔镜胆囊切除联合胆道镜胆总管切开取石组的复发比例低于腹腔镜胆囊切除联合十二指肠镜乳头切开取石组(OR=0.27,95%CI=0.09~0.81,P<0.05)。结论:既往碎石史、合并胆管炎与胰腺炎、胆囊管扩张、胆总管直径>1 cm、内镜乳头切开术均是促进腹腔镜胆囊切除联合胆道镜胆总管切开取石术后结石复发的危险因素。