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目的 总结运用腹腔镜与十二指肠镜、胆道镜联合，微创治疗内镜取石失败的胆管结石病人的治疗经验。方法 从1998年4月至2002年5月，运用三镜联合的手术方式（术前内镜下经鼻胆管引流，腹腔镜胆总管探查术，术中胆道镜），对251例胆总管结石病人进行微创治疗。结果 240例手术均获成功，11例中转开腹、无残余结石及严重并发症。术后住院时间明显缩短，操作熟练后手术时间也短于开腹手术。194例随访半年以上未见远期并发症。结论 三镜联合胆总管探查术对于有较高内镜、腹腔镜技术的医疗单位是切实可行和安全可靠的。十二指肠镜、胆道镜及腹腔镜的联合应用优势明显，可基本取代开腹胆总管探查术。

Combined choledochoscopy,duodenoscopy and laparoscopy in treating extrahepatic bile duct stone:report of 251 cases

Objective To summarize the method of applying choledochoscopy, duodenoscopy and laparoscopy to extract common bile duct (CBD) stones that failed to respond to ordinary endoscopic sphincterotomy (EST). Methods From Apr 1998 to May 2002, 251 patients were admitted and received the therapeutical procedures, i.e. endoscopic nasobiliary drainage (ENBD) was first adopted, then followed by laparoscopic common bile duct exploration (LCBDE), and finally choledochoscopy was used during operation to clear the stones.Results Satisfactory outcome was realized: 240 cases succeeded, 11 cases converted to laparotomy, neither residual stones nor serious complicaions were observed. The time taken for the multiple endoscopy was less than open choledocholithotomy after the technique practised, and postoperative hospitalization period of the former shortened obviously compard with the latter. No complications occured among 194 patients' follow-up for more than 6 months.Conclusion The combined laparoscopy and endoscopy are practicable and safe in the hands of skill endoscopists.The operation can substitute most open choledocholithotomy.