腹腔镜胆囊切除术联合胆道镜经胆囊管胆总管探查取石术的研究进展

Research Progress in Laparoscopic Cholecystectomy Combined with Choledochoscopic Common Bile Duct Exploration via the Cystic Duct for Stone Removal

摘要: 本文阐述了腹腔镜下胆囊切除联合胆道镜经胆囊管胆总管探查取石术(laparoscopic cholecystectomy, LC, laparoscopic transcystic common bile duct exploration, LTCBDE)在治疗胆囊结石合并胆总管结石中的最新研究进展。胆囊结石合并胆总管结石是一种常见的胆道疾病，传统治疗方法包括腹腔镜胆囊切除 + 胆道探查取石 + T管引流术(laparoscopic cholecystectomy, LC + common bile duct exploration and stone removal + T-tube drainage)；腹腔镜胆囊切除 + 胆道探查取石 + 胆总管I期缝合(laparoscopic cholecystectomy, LC, common bile duct exploration and stone removal + primary closure of common bile duct)；腹腔镜胆囊切除 + 内镜逆行胰胆管造影 + Oddi括约肌切开取石(laparoscopic cholecystectomy, LC + endoscopic retrograde cholangiopancreatography, ERCP + sphincterotomy of Oddi, EST)。近年来，随着快速康复外科学的发展，腹腔镜下胆囊切除联合胆道镜经胆囊管胆总管探查取石术成为治疗胆囊结石合并胆总管结石的新选择。本文系统分析了该手术方式的临床疗效、安全性以及并发症管理，重点探讨了手术成功率、结石残留率及并发症发生率等方面的最新证据。最后，文章展望了未来技术发展方向及临床应用前景，为临床医生选择合适的治疗方案提供理论支持和实践指导。

Abstract: This article elaborates on the latest research progress in laparoscopic cholecystectomy combined with choledochoscopic common bile duct exploration via the cystic duct for stone removal in the treatment of gallstones combined with common bile duct stones. Gallstones combined with common bile duct stones are a common biliary tract disease. Traditional treatment methods include laparoscopic cholecystectomy + common bile duct exploration and stone removal + T-tube drainage; laparoscopic cholecystectomy + common bile duct exploration and stone removal + primary closure of common bile duct; and laparoscopic cholecystectomy + endoscopic retrograde cholangiopancreatography (ERCP) + sphincterotomy of Oddi. In recent years, with the development of enhanced recovery after surgery, laparoscopic cholecystectomy combined with choledochoscopic common bile duct exploration via the cystic duct for stone removal has emerged as a new option for treating gallstones combined with common bile duct stones. This article systematically analyzes the clinical efficacy, safety, and complication management of this surgical approach, focusing on the latest evidence regarding surgical success rates, residual stone rates, and complication rates. Finally, the article discusses future technological development directions and clinical application prospects, providing theoretical support and practical guidance for clinicians in selecting appropriate treatment strategies.