探讨腹腔镜胆囊切除术（LC）联合腹腔镜经胆囊管胆总管探查取石术（LTCBDE）一期缝合在胆囊结石合并胆总管结石经ERCP取石失败患者中应用的疗效。

回顾性分析2020年1月至2024年12月广西医科大学附属武鸣医院收治的158例胆囊结石合并胆总管结石经ERCP取石失败患者的临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男70例，女88例；年龄25~84岁，中位年龄54岁。根据术式不同分组，其中一期缝合组（62例）采用LC+LTCBDE+一期缝合，T管引流组（96例）采用LC+腹腔镜胆总管切开取石（LCBDE）+T管引流术。

所有患者均成功接受腹腔镜手术治疗，无中转开腹手术，无死亡病例。一期缝合组术中出血量为21（18，23） ml，明显少于T管引流组的31（29，34） ml（Z=-9.557，P<0.001）。一期缝合组的术后首次肛门排气时间、抗生素使用时间、术后住院时间分别为2.0（1.0，2.0）、5.0（3.0，6.0）、7.0（5.0，8.0）d，明显短于T管引流组的2.5（2.0，4.0）、7.0（5.0，8.0）、9.0（7.0，10.8）d（Z=-5.289，-6.182，-6.246；P<0.001）。一期缝合组术后急性胆管炎、胆漏、结石残留发生率分别为10% （6/62）、2% （1/62）、6% （4/62），T管引流组相应为10%（10/96）、6%（6/96）、15%（14/96），2组比较差异均无统计学意义（P>0.05）。一期缝合组术后腹腔感染的发生率为8%（5/62），明显低于T管引流组的22%（21/96），差异有统计学意义（χ²=5.226，P=0.022）。两组术后均未发生急性胰腺炎和胆管狭窄。

对于胆囊结石合并胆总管多发结石行初次ERCP取石失败患者，在胆囊管直径允许通过胆道镜的前提下，采用LC联合LTCBDE一期缝合可以有效去除结石，减轻手术创伤，减少抗生素使用，缩短术后住院时间，促进患者术后快速恢复，是一种安全、有效、可行的手术方式。

To evaluate clinical efficacy of laparoscopic cholecystectomy (LC) combined with laparoscopic transcystic bile duct exploration (LTCBDE) and primary suture in patients with cholecystolithiasis complicated with choledocholithiasis after failed endoscopic retrograde cholangiopancreatography (ERCP).

Clinical data of 158 patients with cholecystolithiasis and choledocholithiasis who experienced failed ERCP in Wuming Hospital of Guangxi Medical University from January 2020 to December 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 70 patients were male and 88 female, aged from 25 to 84 years, with a median age of 54 years. All patients were divided into two groups according to different surgical procedures. In the primary suture group, patients were treated with LC+LTCBDE+primary suture (n=62), and those in the T-tube drainage group received LC+LCBDE+T-tube drainage (n=96).

All patients were successfully treated by laparoscopic surgery with no conversion to open surgery or death. Intraoperative blood loss in the primary suture group was 21(18,23) ml, significantly less than 31(29,34) ml in the T-tube drainage group (Z=-9.557, P<0.001). In the primary suture group, the time to first flatus, duration of antibiotic use and the length of hospital stay were 2.0(1.0,2.0), 5.0(3.0,6.0) and 7.0(5.0,8.0)d, significantly shorter than 2.5(2.0,4.0),7.0(5.0,8.0) and 9.0(7.0,10.8)d in the T-tube drainage group (Z=-5.289,-6.182,-6.246; all P<0.001). In the primary suture group, the incidence rates of postoperative acute cholangitis, bile leakage and residual stones were 10%(6/62), 2%(1/62) and 6%(4/62), compared with 10%(10/96), 6%(6/96) and 15%(14/96) in the T-tube drainage group. No significant differences were noted between two groups (all P>0.05). The incidence of postoperative abdominal infection in the primary suture group was 8%(5/62), significantly lower than 22%(21/96) in the T-tube drainage group, and the difference was statistically significant (χ²=5.226, P=0.022). No acute pancreatitis or biliary stenosis occurred in two groups after surgery.

For patients with cholecystolithiasis complicated with multiple common bile duct stones after failed ERCP, if the choledochoscope can pass through the diameter of cystic duct, LC combined with LTCBDE and primary suture can effectively remove the stones, mitigate surgical trauma, reduce antibiotic use, shorten the length of postoperative hospital stay and promote rapid postoperative recovery, which is a safe, effective and feasible surgical procedure.