不同内镜联合方式治疗胆总管结石合并胆囊结石临床比较

目的探讨腹腔镜联合胆道镜以及十二指肠镜治疗胆总管结石合并胆囊结石的临床效果，为临床选择合理术式提供参考。方法选择104例胆总管结石合并胆囊结石患者，按照术式分为对照组（48例）与观察组（56例）。对照组实施联合腹腔镜及十二指肠镜治疗，观察组实施胆道镜联合腹腔镜治疗，对比两组患者手术时间、禁食时间、治疗成本、住院时间、排气时间、手术成功率、结石残留率、并发症发生率等指标。结果观察组手术时间、住院时间、治疗成本分别为（182.27±26.68）min、（9.98±3.14）d、（8124.39±663.54）元，均优于对照组，差异有统计学意义（ P ＜0.05）。观察组手术成功率为94.55％，结石残留率为3.64％，与对照组差异无统计学意义（ P ＞0.05）。两组患者感染率差异无统计学意义（ P ＞0.05），观察组血清淀粉酶异常率为5.45％、胆管炎发生率为5.45％、胆管积气发生率为3.64％，均明显低于对照组，差异有统计学意义（ P ＜0.05））。结论腹腔镜联合胆道镜治疗胆总管结石合并胆囊结石临床效果好，安全性高，相比腹腔镜联合十二指肠镜并发症发生率低，治疗成本低，值得临床推广应用。

Clinical analysis of different endoscopic therapies for cholecystolithiasis with choledocholith

Objective To investigate the clinical effect of different endoscopic therapies on cholecystolithiasis with choledocholith, so as to provide a reference for clinical treatment. Methods A total of 104 cases of cholecystolithiasis with choledocholith patients were se-lected and divided into control group and observation group according to the surgical way. 48 patients in the control group received joint duod-enoscopy and laparoscopic treatment,while 56 patients in the observation group were treated with laparoscopic biliary and endoscopic thera-py,then the surgery time,fasting time,the cost of treatment,hospitalization,discharge time,success rate,residual stone rate,complication rate and other indicators were compared between the two groups. Results In observation group,the operative time,hospital stay,cost of treatment were(182. 27 ± 26. 68)min,(9. 98 ± 3. 14)d,(8 124. 39 ± 663. 54)yuan,respectively,which were better than those of the control group,and the difference was statistically significant(P < 0. 05);in the observation group,success rate was 94. 55% ,residual stone rate was 3. 64% ,and compared with the control group,the difference was not statistically significant(P > 0. 05);infection rate showed no difference between the two groups(P > 0. 05);in observation group serum amylase abnormal rate was 5. 45% ,incidence of cholangitis was 5. 45% ,biliary product gas incidence was 3. 64% ,which were significantly lower than those of the control group,and the difference was sta-tistically significant( P < 0. 05). Conclusion For cholecystolithiasis with choledocholith,laparoscopic joint choledochoscope treatment shows good clinical results with high safety,and compared to laparoscopy combined duodenoscopy treatment,the complication rate,cost of treatment are low,thus it is worth clinical application.