探讨腹腔镜胆总管探查术（LCBDE）胆道镜取石联合十二指肠镜顺行留置鼻胆管胆总管一期缝合的手术方法的安全性和有效性。

研究对象为2020年1月至2022年1月海军军医大学第三附属医院和安徽省宣城市人民医院收治的200例胆总管结石患者。其中男73例，女127例；年龄17~93岁，中位年龄64岁。使用随机数表法将入组患者分为三镜组和两镜组，两组各100例。三镜组采用LCBDE胆道镜取石联合十二指肠镜顺行留置鼻胆管胆总管一期缝合，两镜组行LCBDE胆道镜取石联合胆总管一期缝合。两组手术时间、术中出血量等比较采用t检验或秩和检验，并发症发生率等比较采用χ²检验。分析三镜联合手术的安全性和有效性。

两组术中出血量、中转开腹率、术后腹腔引流管拔除时间、术后住院时间差异均无统计学意义（P>0.05）；三镜组手术时间为（92±18）min，明显长于两镜组的（79±17）min（t=5.339，P<0.001）；三镜组术后胆漏发生率为1%（1/100），明显低于两镜组的7%（7/100） （χ²=4.688，P=0.030），所有胆漏患者均通畅引流1~2周后自愈；围手术期两组均无并发胰腺炎病例。三镜组、两镜组患者胆总管结石复发分别为1、3例，胆总管狭窄各1例，差异无统计学意义（χ²=1.192，P=0.275）。

三镜联合取石顺行留置鼻胆管胆总管一期缝合可加速患者术后康复，缩短术后住院时间，降低胆漏发生率。

To evaluate the safety and efficacy of laparoscopic common bile duct exploration (LCBDE) combined with choledochoscopy and antegrade indwelling of nasobiliary catheter with duodenoscopy, and primary suture of common bile duct.

200 patients with common bile duct stones admitted to the Third Affiliated Hospital of Naval Medical University and Xuancheng People’s Hospital from January 2020 to January 2022 were enrolled in this study. Among them, 73 patients were male and 127 female, aged from 17 to 93 years, with a median age of 64 years. All patients were randomly divided into triple-endoscopy (n=100) and double-endoscopy groups (n=100). In the triple-endoscopy group, LCBDE combined with choledochoscopy and antegrade indwelling nasobiliary catheter with duodenoscope, and primary suture of common bile duct was adopted. In the double-endoscopy group, LCBDE with choledochoscopic lithotomy and primary suture of common bile duct was employed. The operation time and intraoperative blood loss between two groups were compared by t test and rank-sum test. The incidence of complications between two groups was compared by Chi-square test. The safety and efficacy of triple-endoscopy combined surgery were evaluated.

No significant differences were observed in intraoperative blood loss, conversion rate to open surgery, removal time of postoperative abdominal drainage tube and the length of postoperative hospital stay between two groups (all P>0.05). The operation time in the triple-endoscopy group was (92±18) min, significantly longer than (79±17) min in the double-endoscopy group (t=5.339, P<0.001). The incidence of postoperative bile leakage in the triple-endoscopy group was 1%(1/100), significantly lower than 7%(7/100) in the double-endoscopy group (χ²=4.688, P=0.030). All patients with bile leakage were recovered at 1-2 weeks after drainage. No intraoperative pancreatitis was observed in two groups. In the triple-endoscopy group, 1 patient developed recurrence of common bile duct stones and 1 case of common bile duct stenosis, and 3 and 1 in the double-endoscopy group, with no statistical significance between two groups (χ²=1.192, P=0.275).

LCBDE combined with choledochoscopy lithotomy and antegrade indwelling nasobiliary catheter and primary suture of common bile duct can accelerate postoperative rehabilitation, shorten the length of postoperative hospital stay and reduce the incidence of bile leakage.