目的：探讨十二指肠镜联合腹腔镜治疗老年胆囊结石合并肝外胆管结石患者的临床疗效。方法：选取2011年1月—2015年6月收治的老年胆囊结石合并肝外胆管结石患者120例，依据手术方式的选择分为对照组与观察组，每组各60例。对照组采用传统开腹胆囊切除、胆总管切开取石及T管引流术治疗，观察组采用十二指肠镜切开取石联合腹腔镜胆囊切除术的微创手术治疗，比较两组患者的相关临床指标及疗效。结果：与对照组比较，观察组术中出血量（60.74 mL vs. 98.42 mL）、住院时间（10.8 d vs. 12.3 d）明显减少，但手术时间（3.12 h vs. 2.06 h）、住院费用（18 047.53元vs. 12 054.88元）明显增加（均P<0.05）；疼痛评分（3.8 vs. 4.9）明显降低、肠道功能恢复时间（1.8 d vs. 3.5 d）与腹腔引流时间（1.7 d vs. 3.3 d）明显减少，胃肠道不良反应发生率（10.0% vs. 25.0%）明显降低（均P<0.05）；总并发症的发生率（20.0% vs. 41.7%）明显降低，但急性胰腺炎（16.7% vs. 3.3%）的发生率增高（均P<0.05）。术后随访，观察组反流性胆管炎发生率（13.3% vs.1.7%）高于对照组，但术后满意率（93.5% vs. 78.2%）、恢复正常生活时间（25.8 d vs. 48.7 d）均优于对照组，观察组与对照组结石复发率（3.3% vs. 6.7%）差异无统计学意义（P>0.05）。结论：十二指肠镜联合腹腔镜治疗老年胆囊结石合并肝外胆管结石的中具有恢复快、并发症低、住院时间短及远期疗效好的优点，充分体现了微创手术的优势。
Therapeutic combined use of duodenoscopy and laparoscopy for elderly patients with gallbladder stones and concomitant extrahepatic bile duct stones
Objective: To investigate the clinical efficacy of the combined use of duodenoscopy and laparoscopy in treatment of gallbladder stones with concomitant extrahepatic bile duct stones in elderly patients. Methods: One-hundred and twenty elderly patients with gallbladder stones and concomitant extrahepatic bile duct stones admitted from January 2011 to June 2015 were selected. According to surgical approaches, the patients were divided into control group and observational group, with 60 cases in each group. Patients in control group underwent traditional open cholecystectomy, common bile duct exploration, and T tube drainage, and those in observational group underwent minimally invasive operation of duodenoscopic sphincterotomy combined with laparoscopic cholecystectomy. The relevant clinical variables and therapeutic results of the two groups of patients were compared. Results: In observational group compared with control group, the intraoperative blood loss (60.74mL vs. 98.42 mL) and length of hospital stay (10.8 d vs. 12.3 d) were significantly decreased, the operative time (3.12 h vs. 2.06 h) and hospitalization costs (18 047.53 yuan vs. 12 054.88 yuan) were significantly increased (all P<0.05), the pain score (3.8 vs. 4.9) was significantly decreased, time to intestinal function recovery (1.8 d vs. 3.5 d) and peritoneal drainage time (1.7 d vs. 3.3 d) were significantly shortened, and incidence of gastrointestinal adverse reactions (10.0% vs. 25.0%) were significantly reduced (all P<0.05). The overall incidence of postoperative complications (20.0% vs. 41.7%) was significantly decreased, but incidence of acute pancreatitis (16.7% vs. 3.3%) was increased (all P<0.05). During follow-up, in observational group, the incidence of reflux cholangitis was significantly higher than that in control group (13.3% vs.1.7%), but postoperative satisfaction rate (93.5% vs. 78.2%) and time to restore normal activities (25.8 d vs. 48.7 d) were all better than those in control group (all P<0.05), while the stone recurrence rate of observational group and control group (3.3% vs. 6.7%) had no statistical difference (P>0.05). Conclusion: Therapeutic combined use of duodenoscopy and laparoscopy for elderly patients with gallbladder stones and concomitant extrahepatic bile duct stones has the advantages of quick recovery, reduced complications, short length of hospital stay and favorable long-term efficacy, and fully reflects the superiorities of minimally invasive surgery.