探讨胆囊切除联合术后内镜下逆行性胰胆管造影术（ERCP）治疗胆囊结石合并胆总管结石患者的临床价值。

本研究回顾性分析2010年6月至2012年9月在中山大学孙逸仙纪念医院和中山大学附属第三医院收治的50例胆囊结石合并胆总管结石患者的临床资料。患者均签署知情同意书，符合医学伦理学规定。根据治疗方法将患者分为胆囊切除联合术后ERCP取石组（ERCP取石组）和胆囊切除+胆总管切开取石组（胆总管切开取石组）。ERCP取石组26例，男12例，女14例，年龄（37±4）岁；胆总管切开取石组24例，男11例，女性13例，年龄（40±4）岁。观察两组患者的手术情况、总住院时间、术后住院时间、术后胆道结石残余及并发症发生情况。两组患者的总住院时间、术后住院时间比较采用t检验，术后胆道结石残余率及并发症发生率比较采用χ²检验。

两组患者的手术顺利完成。ERCP取石组的总住院时间为（16±2）d，明显短于胆总管切开取石组的（21±2）d（t=8.742，P<0.05）；ERCP取石组的平均术后住院时间为（12±2）d，亦明显短于胆总管切开取石组的（17±2）d（t=8.248，P<0.05）；ERCP取石组发生1例（4%）胆道残余结石，胆总管切开取石组发生6例（25%）胆管残余结石，ERCP取石组的胆道残余结石率明显少于胆总管切开取石组（χ²=3.05，P<0.05）。ERCP取石组的并发症发生率为4%（1/26），胆总管切开组的并发症发生率为25%（6/24），ERCP取石组的并发症发生率明显低于胆总管切开取石组（χ²=3.05，P<0.05）。

胆囊切除联合ERCP取石治疗胆囊结石合并胆总管结石可以明显降低胆道结石残余率，是一种安全、有效的治疗方式。

To assess the efficacy of cholecystectomy together with endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of cholecystolithiasis complicated with choledocholithiasis.

Clinical data of 50 patients with cholecystolithiasis complicated with choledocholithiasis admitted in Sun Yat-sen Memorial Hospital and the Third Affiliated Hospital of Sun Yat-sen University from June 2010 to September 2012, were studied retrospectively. The informed consents of all patients were obtained and the ethics committee approval was received. According to the surgical procedures, the patients were divided into two groups: the cholecystectomy combined with postoperative ERCP group (ERCP group) [26 cases; 12 males and 14 females; (37±4) years old] and cholecystectomy+choledocholithotomy group (choledocholithotomy group) [24 cases; 11 males and 13 females; (40±4) years old]. The operations, total hospital stay, postoperative hospital stay, the incidence of residual bile duct stones and complications were observed. The total hospital stay and postoperative hospital stay were compared by t-test. The incidence of residual bile duct stones and complications were compared by χ² test.

The operations in both groups were successfully performed. The total hospital stay of the ERCP group was (16±2) d, which was shorter than that in the choledocholithotomy group (12±2) d(t=8.248, P<0.05). There was 1 case (4%) of patients had residual bile duct stones, while in the choledocholithotomy group, there were 6(25%) patients suffered residual bile duct stones. The incidence of residual bile duct in the ERCP group was statistically significant less than that in the choledocholithotomy group (χ²=3.05, P<0.05). The incidence of postoperative complications was 4%(1/26) in the ERCP group and 25%(6/24) in the choledocholithotomy group respectively. There was significant difference in the 2 groups (χ²=3.05, P<0.05).

The cholecystectomy together with postoperative ERCP is safe and effective in the treatment of cholecystolithiasis complicated with choledocholithiasis. It can also reduce the incidence of residual bile duct stones.