不同术式治疗胆囊结石合并胆总管结石的应用进展

胆囊结石合并胆总管结石是一种常见的胆道系统疾病，多数患者因不能自行排解而需手术清除结石，解除梗阻症状，并且控制其复发，减少术后并发症。手术治疗方式主要有开腹胆囊切除术+胆总管切开取石+T管引流术、腹腔镜胆囊切除术（LC）+经内镜逆行性胰胆管造影/乳头括约肌切开取石术（ERCP/EST）、LC+腹腔镜胆总管探查（LCBDE）+胆总管一期缝合或T管引流术、LC+胆总管切开取石术+LCBDE +经内镜拟行留置鼻胆管（ENBD），其中以ERCP+LC与LCBDE+LC应用最广泛。外科医师应熟知不同手术方式的适应证和疗效，综合考虑患者的身体条件、结石大小和数量、胆总管的解剖因素、经济条件，理性地选择治疗方式，往往可以取得事半功倍的效果。

Application progress of different surgical methods in treating cholecystolithiasis combined with choledocholithiasis

Cholecystolithiasis combined with choledocholithiasis is a common biliary system disease. Patients often need surgical treatment to remove stones, relieve obstruction symptoms, control the recurrence and reduce postoperative complications. There are many surgical methods to cure this disease, including open cholecystectomy+choledocholithotomy+T tube drainage, laparoscopic cholecystectomy (LC)+choledochal exploration (LCBDE)+common bile duct suture or T tube drainage, LC+endoscopic cholangiopancreatography/papillary sphincterotomy (ERCP/EST), LC+choledocholithotomy+LCBDE+endoscopic drainage of nasogastric bile duct (ENBD). ERCP+LC and LCBDE+LC are the most widely used. Surgeons should be well aware of the indications and effects of different surgical methods, taking into account the patients' physical conditions, the size and quantity of stones, anatomical factors of the common bile duct, the economic conditions, and rationally choose appropriate treatment to achieve remarkable clinical effects.