探讨内镜下鼻胆管引流术（ENBD）联合腹腔镜胆总管探查术（LCBDE）、腹腔镜胆囊切除术（LC）治疗胆囊结石合并胆总管结石的临床疗效。

回顾性分析2014年12月至2015年11月复旦大学附属华山医院收治的79例胆囊结石合并胆总管结石患者临床资料。其中男34例，女45例；年龄21～99岁，中位年龄57岁。所有患者均签署知情同意书，符合医学伦理学规定。根据手术方式不同，将患者分为ENBD+LCBDE+LC（16例），ERCP+LC（41例）及LCBDE+LC （22例）组。3组患者住院费用比较采用单因素方差分析和LSD-t检验，结石残余率和并发症发生率比较采用Fisher确切概率法。

ENBD+LC+LCBDE、ERCP+LC、LCBDE+LC组的平均住院费用分别为（2.38±0.17）、（2.83±0.25）、（2.16±0.22）万元，ENBD+LC+LCBDE组和LCBDE+LC组明显低于ERCP+LC组（LSD-t=-4.352，-3.147；P<0.05）。ERCP+LC组术后发生胰腺炎9例，反流性胆管炎2例，并发症发生率为27%（11/41）；LCBDE+LC组术后发生胆漏2例，并发症发生率为9%（2/22）；ENBD+LCBDE+LC组无发生并发症，3组差异有统计学意义（P=0.027）。ENBD+LC+LCBDE、ERCP+LC、LCBDE+LC组的结石残余率分别为0（0/16）、5%（2/41）、4%（1/22），差异无统计学意义（P=1.000）。

ENBD+LC+LCBDE三镜联合治疗胆囊结石合并胆总管结石是一种安全有效的术式，其保留了Oddi括约肌功能，明显降低术后并发症发生率。

To investigate the clinical efficacy of endoscopic nasobiliary drainage (ENBD) combined with laparoscopic common bile duct exploration (LCDBE) and laparoscopic cholecystectomy (LC) in treating cholecystolithiasis complicated with choledocholithiasis.

Clinical data of 79 patients with cholecystolithiasis complicated with choledocholithiasis admitted to Huashan Hospital of Fudan University between December 2014 and November 2015 were retrospectively analyzed. There were 34 males and 45 females, aged from 21 to 99 years old with a median age of 57 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different surgical procedures, the patients were divided into the ENBD+LCBDE+LC group (n=16), the ERCP+LC group (n=41) and the LCBDE+LC group (n=22). The hospitalization expense in three groups was compared using one-way analysis of variance and LSD-t test. The rate of residual stone and the incidence of complications were compared using Fisher's exact probability test.

The average hospitalization expense in the ENBD+LCBDE+LC group and LCBDE+LC group were respectively (2.38±0.17)×10⁴ and (2.16±0.22)×10⁴ yuan, significantly less than (2.83±0.25) ×10⁴ yuan in the ERCP+LC group (LSD-t=-4.352, -3.147; P<0.05). In the ERCP+LC group, pancreatitis was observed in 9 cases and refluxing cholangitis in 2 cases after operation, and the incidence of complications was 27% (11/41). In the LCBDE+LC group, bile leakage was observed in 2 cases after operation, and the incidence of complications was 9%(2/22). No postoperative complication was observed in the ENBD+LCBDE+LC group. Significant difference was observed in the incidence of complications among three groups (P=0.027). The rate of residual stone in the ENBD+LC+LCBDE, ERCP+LC and LCBDE+LC groups was respectively 0(0/16), 5%(2/41) and 4%(1/22), and no significant difference was observed (P=1.000).

Combined use of ENBD, LC and LCBDE is a safe and effective treatment for cholecystolithiasis complicated with choledocholithiasis. It preserves the function of sphincter of Oddi and significantly reduces the incidence of postoperative complications.