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目的探讨不同情况下肝外胆管结石的内镜、腹腔镜及其联合治疗的最佳方法，并创建微创治疗肝外胆管结石的阶梯性方案。方法选择自1998年4月至2003年6月收治的2718例肝外胆管结石病人，随机抽取50例行开腹胆道探查、T管引流术作为对照组。其余根据内镜治疗结果及结石的具体情况分别采用一镜方案、二镜方案(二镜方案①或二镜方案②)、三镜方案治疗。将微创方案治疗结果及术后临床指标与对照组进行对比分析。结果阶梯性应用4种微创方案治疗肝外胆管结石病人2668例，治疗成功率为97．79％，术后均无严重并发症发生。几种微创治疗方案均较开腹对照组成功率高，创伤小，住院时间明显缩短。结论该方案针对不同类型、不同程度的肝外胆管结石病人阶梯性应用，充分体现了内镜、腹腔镜联合微创治疗的优越性，扩大了微创治疗肝外胆管结石的范围，提高了治疗成功率。

Clinical study on step by step scheme of mini-invasive surgical treatment for extrahepatic bile duct stone

Objective To study the most appropriate approach to treat extrahepatic bile duct stone by duodenoscopy, laparoscopy and choledochoscopy, and to establish a step-by-step scheme of mini-invasive surgical treatment for extrahepatic bile duct stone. Methods Totally 2718 patients with extrahepatic bile duct stones were treated from Apr. 1998 to Jun. 2003. Among these patients, 50 cases were randomly selected to accept open common bile duct exploration and T-tube drainage for case-control study.Other cases underwent the treatment of duodenoscopy at first. According to the outcomes of the treatment of endoscopy and the special conditions of extrahepatic bile duct stones, we proposed a series of schemes,i.e.a scheme of uni-scopy,bi-scopy and cheme tri-scopy.The success rate and post-operative results of the mini-invasive treatment group were observed and analyzed compared with the outcome of the control group. Results The four schemes for various conditions of extrahepatic bile duct stones obtained an overall success rate of 97.79%(2609/2668). There were no serious post-operative complications. The success rate of this serial standardized scheme of mini-invasive surgical treatment was higher than the laparotomy treatment group.The invasion was reduced and hospital stay was obviously shortened. Conclusion The four schemes can be used for various conditions of extrahepatic bile duct stone disease step by step. It utilizes the advantages of techniques of digestive endoscopies and laparoscopy and shows fully the characteristics of mini-invasive surgical means,thus expanding the therapeutic scope of mini-invasive surgery and improving the success rate for complicated extrahepatic bile duct stone.