1.南京市鼓楼医院高淳分院，普外科，江苏 南京 211300;2.南京市鼓楼医院高淳分院，消化内科，江苏 南京 211300
1.Department of General Surgery, Gaochun Branch, Nanjing Gulou Hospital, Nanjing, Jiangsu 211300, China;2.Department of Gastroenterology, Gaochun Branch, Nanjing Gulou Hospital, Nanjing, Jiangsu 211300, China
目的 探讨三镜联合“一步法”与内镜下逆行胰胆管造影（ERCP）、内镜下十二指肠乳头括约肌切开术（EST）联合腹腔镜下胆囊切除术（LC）在胆总管结石合并胆囊结石中的治疗效果。方法 选取该院2018年1月－2019年8月收治的72例胆总管结石合并胆囊结石患者作为研究对象，所有患者以随机数表法分为观察组与对照组，每组36例。观察组行三镜联合“一步法”治疗，对照组行ERCP/EST联合LC治疗。对比两组患者围术期相关临床指标（术中出血量、术后排便时间、住院时间、医疗费用、结石清除率、中转开腹率）及术后不同时点疼痛视觉模拟评分（VAS）的差异，统计两组患者住院期间并发症发生情况。结果 两组患者性别、年龄、体重指数（BMI）和结石直径比较，差异均无统计学意义（P > 0.05）。观察组术中出血量、术后排便时间、住院时间和医疗费用明显少于对照组，差异均有统计学意义（P < 0.05）；两组患者结石清除率、中转开腹率比较，差异均无统计学意义（P > 0.05）。两组患者术后不同时点VAS评分比较，差异均无统计学意义（P > 0.05）。观察组术后并发症总发生率8.33%明显低于对照组27.78%，差异有统计学意义（P < 0.05）。结论 与ERCP/EST联合LC相比，三镜联合“一步法”治疗胆总管结石合并胆囊结石，术后恢复快，患者经济压力小，且术后并发症发生率低，值得临床应用。
Objective To explore the therapeutic effect of three lens combined with one-step method, endoscopic retrograde cholangiography, sphincterotomy (ERCP/EST) combined with laparoscopic cholecystectomy (LC) in choledocholithiasis and cholecystolithiasis.Methods 72 patients with choledocholithiasis and cholecystolithiasis from January 2018 to August 2019 were included in the study. All the patients were randomly divided into observation group and control group with 36 patients in each group. The observation group received three-lens combined with one-step therapy, while the control group received ERCP/EST combined with LC. The perioperative clinical indicators (intraoperative blood loss, postoperative defecation time, hospital stay, medical expenses, stone removal rate, conversion rate to laparotomy) and VAS scores at different postoperative points were compared between the two groups. In addition, complications occurred during hospitalization in the two groups were statistically analyzed.Results There was no significant difference in gender, age, body mass index and stone diameter between the two groups (P > 0.05). The amount of intraoperative blood loss, postoperative defecation time, hospital stay and medical expenses in the observation group were significantly lower than those in the control group, with statistically significant differences (P < 0.05).There was no significant difference in stone clearance rate and conversion rate between the two groups (P > 0.05). There was no significant difference in VAS score between the two groups at different time points (P > 0.05).The total incidence of postoperative complications in the observation group was 8.33%, which was significantly lower than that in the control group (27.78%) (P < 0.05).Conclusion Compared with ERCP/EST combined with Lc, three mirrors combined with "one-step method" in the treatment of choledocholithiasis combined with cholecystolithiasis have fast postoperative recovery, low economic pressure and low incidence of postoperative complications, which is worthy of clinical application.