Comparative clinical efficacy in the treatment of gallbladder stones combined with non-expanding common bile duct stones

doi:10.3877/cma.j.issn.1674-0793.2026.02.005

Abstract

Abstract:

Objective

To compare the clinical efficacy of laparoscopic commom bile duct exploration+laparoscopic cholecystectomy (LTCBDE+LC) versus endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy+laparoscopic cholecystectomy (ERCP/EST+LC) in the treatment of patients with gallbladder stones and non-expanding common bile duct stones.

Methods

A retrospective analysis was conducted on the relevant data of 98 patients with gallbladder stones and non-expanding common bile duct stones from August 2020 to August 2025 in Fuyang City Tumor Hospital. 50 patients underwent LTCBDE + LC (surgical group), and 48 patients underwent ERCP/EST + LC (endoscopic group). The preoperative and intraoperative data, postoperative recovery conditions, and complications of the two groups of patients were observed.

Results

There was no statistically significant difference in the preoperative baseline data and laboratory tests between the two groups. The intraoperative blood loss of the surgical group (23.68±8.97) ml was comparable to that of the endoscopic group (25.90±9.80) ml, with no significantly statistical difference. The operation time of the surgical group (105.76±21.47) min was significantly shorter than that of the endoscopic group (146.67±23.19) min, with statistical difference (P<0.05). The postoperative time to get out of bed, postoperative defecation time, postoperative removal time of abdominal drainage tube/nasobiliary tube, and postoperative pain score of the surgical group were significantly better than those of the endoscopic group [(6.88±2.36) h, (19.63±4.93) h, (4.02±0.33) d, (2.65±1.08) points], with statistical differences (P<0.05). The postoperative hospital stay and treatment cost of the surgical group (3.84±0.89) days and (25 624.46±2 599.82) yuan were also significantly better than those of the endoscopic group [(6.42±1.15) days, (28 672.56±3 835.13) yuan], with statistical differences (P<0.05). The overall complication rate of the endoscopic group (27.08%) was significantly higher than that of the surgical group (10.00%), with statistical difference (P<0.05).

Conlusions

Compared with ERCP/EST + LC, LTCBDE + LC can reduce intraoperative blood loss, accelerate postoperative recovery, reduce treatment costs, and decrease postoperative complications. Under the premise of strictly controlling the surgical indications, it is worthy of clinical application.

Key words: Biliary exporation, Non-expanding, Common bile duct stone, Gallstone, Endoscope

Haoran Yang, Yuzhen Bai, Qifeng Lu. Comparative clinical efficacy in the treatment of gallbladder stones combined with non-expanding common bile duct stones[J]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(02): 98-102.

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URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2026.02.005

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References 22

［1］	刘楠, 刘奇, 陈德兴. 腹腔镜下经胆囊管切开胆总管探查取石术的研究进展[J]. 中国微创外科杂志, 2024, 24(5): 363-368.
［2］	杨军凯, 郝泽东, 郭文亮, 等. 同期三镜联合钬激光治疗胆囊结石合并胆总管结石: 前瞻性随机对照研究[J]. 中国微创外科杂志, 2025, 25(7): 398-404.
［3］	Han SJ, Chang JH, Gweon TG, et al. Analysis of symptomatic recurrences of common bile ducts stones after endoscopic removal: factors related to early or multiple recurrences[J]. Medicine (Baltimore), 2022, 101(3): e28671.
［4］	刘本杰, 吴景松, 张煌雄. 腹腔镜下经胆囊管柱状球囊扩张治疗继发胆总管结石的临床研究[J]. 浙江创伤外科, 2025, 30(7): 1349-1351.
［5］	刘立民, 张宗明, 张翀, 等. 改良腹腔镜经胆囊管胆总管探查术治疗胆总管结石的疗效分析[J/OL]. 中华普通外科学文献(电子版), 2025, 19(5): 320-324.
［6］	张天献, 吕云福, 郑进方. LC+LCBDE与ERCP/EST+LC治疗胆囊结石合并胆总管结石效果Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(1): 45-50.
［7］	郭志唐, 龙奎, 王琳, 等. 腹腔镜经胆囊管胆总管探查术治疗继发性胆总管结石32例报告[J]. 腹腔镜外科杂志, 2025, 30(4): 273-277.
［8］	Liu F, Ye L, Wang Y, et al. Short-term efficacy of LCBDE+LC versus ERCP/EST+LC in the treatment of cholelithiasis combined with common bile duct stones: A retrospective cohort study[J]. J Laparoendosc Adv Surg Tech A, 2025, 35(2): 145-151.
［9］	郭晋芳, 张健康, 李悦. 十二指肠镜下乳头括约肌切开术及气囊扩张术治疗非扩张性肝外胆管结石的疗效分析[J]. 现代消化及介入诊疗, 2022, 27(8): 956-960, 965.
［10］	Xu S, Deng C, Tang K, et al. The effect of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration in treatment of cholecystolithiasis combined with choledocholithiasis[J]. Updates Surg, 2025, 77(2): 493-499.
［11］	Huang J, Hu W, Liu J, et al. Laparoscopic transcystic common bile duct exploration: 8-year experience at a single institution[J]. J Gastrointest Surg, 2023, 27(3): 555-564.
［12］	王勇, 陈石磊, 胡小四, 等. 两孔法LC联合超细胆道镜经胆囊管胆总管探查术治疗35例胆囊结石合并胆总管结石患者的研究[J]. 中华肝胆外科杂志, 2025, 31(3): 197-201.
［13］	朱梁飞, 王小永, 姚杰, 等. 双镜联合胆总管一期缝合术治疗老年胆囊结石合并胆总管结石的疗效及对肝功能、应激反应的影响[J]. 中国普通外科杂志, 2024, 33(8): 1330-1336.
［14］	Guo T, Wang L, Xie P, et al. Surgical methods of treatment for cholecystolithiasis combined with choledocholithiasis: six years’ experience of a single institution[J]. Surg Endosc, 2022, 36(7): 4903-4911.
［15］	Elmunzer BJ, Foster LD, Serrano J, et al. Indomethacin with or without prophylactic pancreatic stent placement to prevent pancreatitis after ERCP: A randomised non-inferiority trial[J]. Lancet, 2024, 403(10425): 450-458.
［16］	Cahyadi O, Tehami N, de-Madaria E, et al. Post-ERCP pancreatitis: prevention, diagnosis and management[J]. Medicina (Kaunas), 2022, 58(9): 1261.
［17］	张小静. 胆总管结石患者ERCP术后胰腺炎的危险因素分析和风险评分系统建立[D]. 长春: 吉林大学, 2025.
［18］	柴欣, 金铁俊, 刘文超, 等. 腹腔镜经胆囊管胆道探查取石的专家共识(2025年版)[J]. 中国微创外科杂志, 2025, 25(8): 449-456.
［19］	彭沙沙, 裴斐. 腹腔镜胆囊管汇入部微切开胆总管探查取石一期缝合术的临床疗效[J]. 国际外科学杂志, 2022, 49(8): 528-532.
［20］	Zheng B, Lu Y, Li E, et al. Comparison of the efficacy of LTCBDE and LCBDE for common bile duct stones: A systematic review and meta-analysis[J]. Front Surg, 2025, 11: 1412334.
［21］	徐新明, 于亚平, 孙俊, 等. 两种微创手术方式治疗胆囊结石合并胆总管结石的疗效比较[J]. 中国普通外科杂志, 2025, 34(2): 375-382.
［22］	应建义, 王天斌, 张宁宁, 等. 吲哚菁绿荧光导航在腹腔镜经胆囊管胆总管探查取石术中的临床应用[J]. 肝胆胰外科杂志, 2024, 36(9): 530-534.

组别	性别		年龄(岁)^a	BMI(kg/m²）^a	胆总管内径(mm)^a	ALT(U/L)^b	AST(U/L)^b	TBiL(μmol/L)^b	ALB(g/L)^a	AMY(μmol/L)^b
组别	男	女	年龄(岁)^a	BMI(kg/m²）^a	胆总管内径(mm)^a	ALT(U/L)^b	AST(U/L)^b	TBiL(μmol/L)^b	ALB(g/L)^a	AMY(μmol/L)^b
手术组（50例）	22（44.00）	28（56.00）	41.30±13.30	23.30±2.17	5.96±0.95	85.96(30.25, 114.00)	57.86(23.00, 56.00)	17.73(8.95, 21.62)	36.72±2.76	57.04(22.25, 67.75)
内镜组（48例)	19（39.58）	29（60.42）	45.29±16.47	23.24±2.47	5.90±0.86	103.40(41.50, 136.00)	70.81(23.75, 77.75)	16.88(9.47, 19.23)	36.98±4.12	52.40(37.75, 67.00)
统计值	0.196		-1.322	0.129	0.351	0.234	0.378	0.071	-0.363	0.648
P值	0.658		0.189	0.898	0.726	0.628	0.538	0.791	0.717	0.518

组别	性别		年龄(岁)^a	BMI(kg/m²）^a	胆总管内径(mm)^a	ALT(U/L)^b	AST(U/L)^b	TBiL(μmol/L)^b	ALB(g/L)^a	AMY(μmol/L)^b
组别	男	女	年龄(岁)^a	BMI(kg/m²）^a	胆总管内径(mm)^a	ALT(U/L)^b	AST(U/L)^b	TBiL(μmol/L)^b	ALB(g/L)^a	AMY(μmol/L)^b
手术组（50例）	22（44.00）	28（56.00）	41.30±13.30	23.30±2.17	5.96±0.95	85.96(30.25, 114.00)	57.86(23.00, 56.00)	17.73(8.95, 21.62)	36.72±2.76	57.04(22.25, 67.75)
内镜组（48例)	19（39.58）	29（60.42）	45.29±16.47	23.24±2.47	5.90±0.86	103.40(41.50, 136.00)	70.81(23.75, 77.75)	16.88(9.47, 19.23)	36.98±4.12	52.40(37.75, 67.00)
统计值	0.196		-1.322	0.129	0.351	0.234	0.378	0.071	-0.363	0.648
P值	0.658		0.189	0.898	0.726	0.628	0.538	0.791	0.717	0.518

组别	胆总管结石最大径（mm）	胆总管结石数量（个）	手术时间（min）	术中出血量（ml）
手术组（50例）	3.80±0.99	1.46±0.71	105.76±21.47	23.68±8.97
内镜组（48例)	3.52±1.05	1.40±0.61	146.67±23.19	25.90±9.80
t值	1.354	0.481	-9.067	-1.169
P值	0.179	0.632	<0.001	0.245

组别	胆总管结石最大径（mm）	胆总管结石数量（个）	手术时间（min）	术中出血量（ml）
手术组（50例）	3.80±0.99	1.46±0.71	105.76±21.47	23.68±8.97
内镜组（48例)	3.52±1.05	1.40±0.61	146.67±23.19	25.90±9.80
t值	1.354	0.481	-9.067	-1.169
P值	0.179	0.632	<0.001	0.245

组别	术后下床时间（h）	术后排气时间（h）	术后拔管时间（d）	术后疼痛评分（分）	术后住院时间（d）	治疗费用（元）
手术组（50例）	5.56±1.92	17.36±5.12	3.00±0.35	2.06±0.71	3.84±0.89	25 624.46±2 599.82
内镜组（48例)	6.88±2.36	19.63±4.93	4.02±0.33	2.65±1.08	6.42±1.15	28 672.56±3 835.13
t值	-3.027	-2.213	-14.938	-3.180	-12.469	-4.622
P值	0.003	0.029	<0.001	0.002	<0.001	<0.001

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