比较腹腔镜胆总管探查取石术（LCBDE）和内镜下括约肌切开取石术（EST）治疗胆总管结石的安全性和疗效。

回顾性分析2015年1月至2018年12月在山西大学大医院接受诊治的80例胆总管结石患者临床资料。患者均签署知情同意书，符合医学伦理学要求。根据治疗方式的不同，将患者分为LCBDE组和EST组，各40例。其中LCBDE组男22例，女18例；平均年龄（48±2）岁。EST组男24例，女16例；年龄（46±2）岁。观察两组围手术期情况。两组手术时间、住院费用等比较采用t检验，手术成功率、术后并发症发生率比较采用χ²检验。

LCBDE组手术时间、住院费用分别为（103.2±2.3）min、（4.31±0.22）万元，EST组相应为（88.8±2.4）min、（3.48±0.10）万元，差异有统计学意义（t=27.74，13.61；P<0.05）。LCBDE组手术成功率98%（39/40），EST组95%（38/40），差异无统计学意义（χ²=0.17，P>0.05）。LCBDE组术后发生胆漏2例，急性胰腺炎1例，消化道出血1例；EST组术后发生急性胰腺炎3例，消化道出血1例，消化道穿孔2例。LCBDE组术后并发症发生率为10%（4/40），EST组为15%（6/40），差异无统计学意义（χ²=0.46，P>0.05）。两组患者均无发生围手术期死亡。

LCBDE和EST治疗胆总管结石均安全、有效，具有创伤小、并发症少等优点。LCBDE保留了Oddi括约肌的生理功能，对于十二指肠狭窄及Oddi括约肌功能受损的患者尤为适用，且手术费用较低。

To compare the safety and efficacy of laparoscopic common bile duct exploration (LCBDE) and endoscopic sphincterotomy (EST) in the treatment of common bile duct stones.

Clinical data of 80 patients with choledocholithiasis who were diagnosed and treated in Shanxi Dayi Hospital of Shanxi University from January 2015 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different treatments, all the patients were divided into the LCBDE and EST groups, with 40 cases in each group. In LCBDE group, 22 patients were male and 18 female, aged (48±2) years on average. In EST group, 24 patients were male and 16 female, aged (46±2) years on average. Perioperative conditions were observed in two groups. The operation time and hospitalization expenses between two groups were statistically compared by t test. The surgical success rate and incidence of postoperative complications between two groups were compared by Chi-square test.

The operation time and hospitalization expenses in LCBDE group were (103.2±2.3) min and (41 310±220) Yuan, significantly higher than (88.8±2.4) min and (34 480±100) Yuan in EST group (t=27.74, 13.61; P<0.05). The surgical success rate in LCBDE group was 98%(39/40) and 95%(38/40) in EST group, where no significant difference was observed (χ²=0.17, P>0.05). In LCBDE group, biliary leakage occurred in 2 cases, acute pancreatitis in 1 case and gastrointestinal hemorrhage in 1 case. In EST group, acute pancreatitis occurred in 3 cases, gastrointestinal hemorrhage in 1 case and gastrointestinal perforation in 2 cases. The incidence of postoperative complications was 10%(4/40) in LCBDE group and 15%(6/40) in EST group, where no significant difference was observed (χ²=0.46, P>0.05). No perioperative death occurred in two groups.

Both LCBDE and EST are safe and efficacious for treating common bile duct stones with slight trauma and mild complications. LCBDE retains the physiological function of Oddi sphincter, which is especially suitable for patients with duodenal stenosis and Oddi sphincter dysfunction, and yields low cost.