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.