探讨联合应用利胆、排石药物对胆总管细小结石的治疗作用，以期提高其非手术治疗效果。

回顾性分析2014年11月至2018年1月北京电力医院联合应用利胆（33%硫酸镁）、排石（颠茄片、山莨菪碱）药物治疗41例胆总管细小结石（直径≤8 mm，数量≤3个）患者的临床资料。

41例患者排石成功率为73.17%（30/41），其中排石成功组30例（合并急性胆囊炎2例，6.67%），排石数量为1~3（1.1±0.4）个，排石时间为3~16（6.0±3.7） d，住院时间为3~23（12.7±5.2） d，排石失败组11例（合并急性胆囊炎5例，45.45%），排石数量为1~2（1.2±0.4）个，排石时间为5~14（9.4±3.5）d，住院时间为10~23（15.8±4.1）d，两组排石数量及住院时间对比，差异无统计学意义（t=0.086，P=0.032；t=2.014，P=0.051），但排石失败组合并急性胆囊炎比例较高，排石时间明显延长（χ²=6.033，P=0.024；t=2.522，P=0.016）。排石成功组患者排石后的肝功能指标如丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TBil）、结合胆红素（DBil）、γ-谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP），均较排石前显著降低（t=3.369、4.957、5.112、5.231、2.264、2.422，均P<0.05）。随访6~18个月，41例患者肝功能正常，均无胆总管结石复发或再生。

联合应用利胆、排石药物可促进胆总管细小结石排入十二指肠，降低手术治疗胆总管细小结石概率，既可作为胆总管细小结石的非手术治疗方法，又可作为胆总管结石的术前准备措施，以期最大限度地简化治疗手段，减轻患者痛苦，减少治疗隐患。

To explore the therapeutic effects of small choledocholithiasis treated with the combination of choleretic and calculus-removal drugs, so as to improve the effect of non-operative treatment of small choledocholithiasis.

The clinical data of forty-one patients with common bile duct calculi (diameter≤8 mm, number≤3) treated with choleretic (33% magnesium sulfate) and lithotripsy (belladonna tablets, anisodamine) in Beijing Electric Power Hospital from November 2014 to January 2018 were retrospectively analyzed.

The successful rate of stone removal in 41 patients was 73.17%(30/41), of which 30 cases (including 2 cases with acute cholecystitis) were successful group, and 11 cases (including 5 cases with acute cholecystitis) were failure group. Comparison of two groups with acute cholecystitis, stone discharge, stone discharge time and hospital stay showed no significant differences in stone discharge [1-3 (1.1±0.4) vs 1-2 (1.2±0.4), t=0.086, P=0.032] and hospital stay [3-23 (12.7±5.2) dvs 10-23 (15.8±4.1) d, t=2.014, P=0.051], while the failure group had a higher proportion of acute cholecystitis (45.45% vs 6.67%, χ²=6.033, P=0.024) and the time of lithotripsy was significantly prolonged [5-14 (9.4±3.5) d vs 3-16 (6.0±3.7) d, t=2.522, P=0.016]. The liver function indexes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), conjugated bilirubin (DBil), gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) after lithotripsy in the successful group were significantly lower than those before lithotripsy (t=3.369, 4.957, 5.112, 5.231, 2.264, 2.422; all P<0.05). After 6-18 months of follow-up, all 41 patients had normal liver function and no recurrence or regeneration of common bile duct stones.

The combined administration of choleretic and lithagogue drugs can promote the small choledocholithiasis into duodenum, reduce the chance of surgical treatment of small choledocholithiasis, not only as a non-operative treatment for the small choledocholithiasis, but also as a preoperative preparatory measure for the choledocholithiasis, so as to maximize the simplification of treatment, reduce patient pain, decrease treatment risks and avoid unnecessary surgery.