目的：比较腹腔镜胆囊切除术（LC）联合胆总管探查取石术（LCBDE）与逆行性胰胆管造影（ERCP）/经十二指肠镜Oddi括约肌切开术（EST）联合LC治疗胆囊结石合并胆总管结石老年患者的临床疗效。方法：回顾分析中日联谊医院2012年10月—2016年4月94例行微创手术治疗的胆囊结石合并胆总管结石老年患者（60岁以上）的临床资料，其中45例行LC+LCBDE（LC+LCBDE组），49例行ERCP/EST+LC（ERCP/EST+LC组），比较两组的相关临床指标。结果：LC+LCBDE组和ERCP/EST+LC组手术成功率（93.3% vs. 89.8%，P=0.539）及术后并发症发生率（8.9% vs. 10.2%，P=0.892）差异均无统计学差异；LC+LCBDE组住院费用明显低于ERCP/EST+LC组（37 735元vs. 48 260元，P<0.001）；住院时间显短于ERCP/EST+LC组（11.51 d vs. 13.39 d，P=0.015）。两组共81例获随访6~48个月，两组患者结石复发、胆道感染发生率无统计学差异（均P>0.05），均未发生胆道狭窄、胰腺炎、胆管恶变等情况。结论：LC+LCBDE在住院费用及住院时间方面有明显优势，对胆总管结石的大小、数量无限制，且保护了Oddi括约肌功能，对于多数老年患者应作为首选，但临床工作中仍需坚持个体化原则，根据老年患者的病情及技术条件灵活选择手术方式。
Clinical comparison of two minimally invasive procedures for cholecystolithiasis with choledocholithiasis in elderly patients
Objective: To compare the clinical efficacy of laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) versus endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) plus LC for cholecystolithiasis with choledocholithiasis in elderly patients. Methods: The clinical data of 94 elderly patients (over 60 years of age) with gallbladder and common bile duct stones undergoing minimally invasive therapy in China-Japan Union Hospital from October 2012 to April 2016 were retrospectively analyzed. Of the patients, 45 cases received LC plus LCBDE (LC+LCBDE group) and 49 cases had ERCP/EST plus LC (ERCP/EST+LC group), and the main clinical variables between the two groups of patients were compared. Results: In LC+LCBDE group versus ERCP/EST+LC group, the surgical success rate (93.3% vs. 89.8%, P=0.539) and incidence of postoperative complications (8.9% vs. 10.2%, P=0.892) showed no significant difference, but the hospitalization cost was significantly decreased (37 735 yuan vs. 48 260 yuan, P<0.001) and length of hospital stay was significantly shortened (11.51 d vs. 13.39 d, P=0.015). A total of 81 patients from both groups were followed up for 6 to 48 months; the incidence of stone recurrence and biliary tract infections showed no significant difference between the two groups of patients,and no cases of biliary stricture, pancreatitis or malignant transformation of the bile ducts occurred in either group of patients. Conclusion: LC+LCBDE approach has obvious advantages in reducing the cost and length of hospitalization, is not limited by the number and size of the choledocholithiasis, and further, it can preserve the function of the sphincter of Oddi. So, it should be considered as the first choice of option in most elderly patients. However, based on the individualization principle,this procedure should be selected flexibly according to the patients’ and technical conditions.