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目的 探讨腹腔镜联合胆道镜治疗肝内外胆管结石的安全性及疗效.方法 50例肝内外胆管结石患者,其中胆囊结石合并胆总管结石12例行腹腔镜胆囊切除与胆总管切开取石、T管引流;胆囊结石合并胆总管结石并肝内胆管结石18例行腹腔镜胆囊切除、胆总管切开并联合胆道镜取石、T管引流术;胆总管结石并肝内胆管结石20例行腹腔镜胆总管切开联合胆道取石、T管引流术.结果 50例患者均取石成功,出现术后胆漏2例,经积极抗感染,充分引流术后8~10 d胆漏停止;术后胆管出血1例,经保守治疗无效后采用肝右动脉栓塞术治疗.无死亡病例,无中转开腹手术,无明显肝功能损害的并发症.T管引流术后12~14 d经造影检查,46例无残留结石,4例有肝内胆道残余结石(8.0%);术后3~6个月再经T管造影并经T管胆道镜取石术.术后随访6~24个月,B超或CT检查均无结石复发.结论 腹腔镜联合胆道镜取石治疗胆囊结石并肝内外胆管结石具有创伤小、并发症少的优点,该术式安全可行.“,”Objective To investigate the safety and efficacy of laparoscopy combined with choledochoscopy in treatment of intrahepatic and extrahepatic bile duct stones.Methods A total of 50 patients with intrahepatic and extrahepatic bile duct stones were chose.Among them, 12 cases of cholecystolithiasis complicated with choledocholithiasis were treated with laparoscopic cholecystectomy and T tube drainage;18 cases of cholecystolithiasis complicated with choledocholithiasis and hepatolithiasis were treated with laparoscopic cholecystectomy, common bile duct incision and choledochoscope stone removal combined with T tube drainage;20 cases of common bile duct stones complicated with intrahepatic bile duct stones were treated by laparoscopic common bile duct exploration combined with bile duct stone removal and T tube drainage.Results The stone removal surgery were successful in both 50 cases;postoperative bile leakage occurred in 2 cases, after positive anti-infection and adequate drainage for 8-10 d, the bile leakage stopped;1 cases of postoperative bile duct bleeding were treated with right hepatic artery embolization after conservative treatment failed.There were no deaths, no conversion to open surgery, no significant liver function damage complications.After T tube drainage for 12-14d, cholangiography showed that, 46 patients without residual stones, 4 cases with intrahepatic biliary residual stone(8.0%);after 3-6 months of operate, according the T tube cholangiography, T tube choledochoscopic lithotomy surgery was conducted again.Follow-up for 6-24 months, ultrasound or CT scan showed no stone recurrence.Conclusion Laparoscopy combined with choledochoscopy in the treatment of intrahepatic and extrahepatic bile duct stones have the advantages of fewer traumas, less complications.It is safe and feasible.