目的 探讨腹腔镜胆总管切开取石术的优势，总结手术操作经验及常见并发症的预防与处理。方法回顾性分析我院1999年6月至2010年4月期间收治的108 例胆管结石患者行腹腔镜胆总管探查取石术的手术方法、操作要点及并发症的处理。结果 腹腔镜手术成功 105例, 中转开腹3例; 手术时间（120±20） min,出血量（25±5） ml,住院时间（9±1） d; 术后发生胆道出血3例,漏胆7 例,残余结石6 例; 全组无死亡病例。结论 腹腔镜胆总管切开取石术具有创伤小、痛苦轻、恢复快、对腹腔脏器干扰小、住院时间短等优点，值得临床推广。
Objective To discuss the therapeutic effect and safety of laparoscopic cholecystectomy plus laparoscopiccommon bile duct exploration （LC＋LCBDE） and endoscopic retrograde cholangiopancreatography/endoscopic sphincte-rotomy plus LC （ERCP/EST＋LC） for cholecystolithiasis with choledocholithiasis patients with obstructive jaundice. Methods The clinical data of cholecystolithiasis with choledocholithiasis patients with obstructive jaundice from January2011 to June 2012 were analyzed retrospectively. During this period， 48 patients were treated by LC＋LCBDE （LC＋LCBDE group）， and 76 patients by ERCP/EST＋LC （ERCP/EST＋LC group）. Results ①There were no statistical significances in the age， gender， preoperative total bilirubin， alanine aminotransferase， number and maximum diameter of common bile duct stone， and internal diameter of common bile duct in two groups （P＞0.05）. ②No perioperative mortality occurred and no significant differences were observed in terms of stone clearance from the common bile duct， postoperative morbidity， and conversion to open surgery in two groups （P＞0.05）. However， the operative time and post-operative hospital stay in the LC＋LCBDE group were shorter than those in the ERCP/EST＋LC group （P＜0.05）. In addi-tion， the costs of surgical procedure and hospitalization charges in the LC＋LCBDE group were less than those in the ERCP/EST＋LC group （P＜0.05）. Conclusions Both LC＋LCBDE and ERCP/EST＋LC are safe and effective therapies forcholecystolithiasis with choledocholithiasis patients with obstructive jaundice. However， LC＋LCBDE is better for pati-ents’ recovery and cost effective. Especially for patients with common bile duct＞1.0cm in diameter or with multiple common bile duct stones， LC＋LCBDE is the best choice. To sum up， the choice of minimally invasive treatment must be individualized according to the patient’s condition and the availability of local resources.
Objective To analyze the clinical characteristics associated with hospital infections in patients with common bile duct stones treated by endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE), thereby providing a basis for selecting treatment strategies and formulating hospital infection prevention measures for such patients. Methods Patients with common bile duct stones at Jiangsu Provincial People’s Hospital between January 2020 and July 2023 were retrospectively selected and divided into ERCP and LCBDE groups according to their surgical methods. Basic patient data, length of hospital stay, hospitalization costs, perioperative infection-related indicators, and occurance of hospital infections were compared between groups. Results A total of 402 patients were enrolled, with 242 in the ERCP group and 160 in the LCBDE group. Significant differences were noted in smoking, alcohol consumption, history of lung diseases, history of heart diseases, history of cholecystectomy/biliary surgery, presence of cholecystitis, presence of cholecystolithiasis, number of stones, maximum stone diameter, common bile duct diameter, total hospital stay, and total expenses (P<0.05). Twenty-four hours before surgery, except for the neutrophil count, which was slightly higher in the ERCP group than that in the LCBDE group (P=0.043), the infection-related indicators did not differ significantly between the two groups (P>0.05). Twenty-four hours after surgery, the levels of serum white blood cell, neutrophil, and aspartate aminotransferase in the ERCP group were lower than those in the LCBDE group (P<0.05), and the levels of alkaline phosphatase and gamma-glutamyl transferase in the ERCP group were higher than those in the LCBDE group (P<0.05). A total of 179 bile samples were collected and tested, identifying 137 strains of pathogenic bacteria (78 in the ERCP group and 59 in the LCBDE group). In the ERCP group, 42 strains (53.85%) were Gram-negative bacteria, 34 strains (45.59%) were Gram-positive bacteria, and 2 strains (2.56%) were fungi; in the LCBDE group, 33 strains (55.93%) were Gram-negative bacteria and 26 strains (44.07%) were Gram-positive bacteria. No significant difference was observed in the composition of pathogenic bacteria between the two groups (χ2=1.174, P=0.695). Among the 402 patients, 38 cases of hospital infection occurred postoperatively, with an infection rate of 9.45%. The difference in the infection rate between the ERCP group and the LCBDE group were statistically significant (11.98% vs. 5.63%; χ2=4.550, P=0.033). The main sites of infection were bloodstream, lungs, and abdominal-pelvic cavity. Conclusions The predominant pathogens isolated after both ERCP and LCBDE are Gram-negative bacteria. Compared with LCBDE, ERCP has less impact on inflammatory markers, hospital stay, and costs, but has a higher incidence of hospital infections.