探讨高龄患者胆囊结石合并胆总管结石的改良微创手术治疗的安全性及可行性。

回顾性分析南京中医药大学附属昆山市中医院自2012年1月至2017年12月采用内镜引导下逆行胰胆管造影术(ERCP)：内镜下十二指肠乳头括约肌切开术(EST)小切开＋内镜乳头气囊扩张术(EPBD)联合腹腔镜胆囊切除术(LC)对100例70岁以上胆囊结石合并胆总管结石患者进行治疗。

本组100例患者中，1例十二指肠乳头括约肌切开时出血，给予1：10 000肾上腺素黏膜下注射后出血停止、3例出现胰腺炎、2例发生胆管炎，均经内科保守治疗后好转。全组LC术无中转开腹、无死亡病例，LC术后住院时间4～10 d，平均(5.3±2.8)d，随访2～24个月，平均(7.5±5.1)个月，患者无腹痛、黄疸及发热等症状，复查超声未见胆管结石复发。

改良ERCP＋(EST＋EPBD)联合LC术治疗高龄患者胆囊结石合并胆总管结石操作手术成功率高、并发症少、术后恢复快，是一种有效且安全可靠的微创治疗术式，值得推广。

To explore the safety and feasibility of modified minimally invasive surgery for cholecystolithiasis and choledocholithiasis in elderly patients.

We conducted a retrospective analysis of 100 patients more than 70 years old with cholecystolithiasis and choledocholithiasis performed by modified endoscopic retrograde cholangio-pancreatography (endoscopic sphincterotomy small incision + endoscopic papillary balloon dilation) combined with laparoscopic cholecystectomy from January 2012 to December 2017 in the Traditional Chinese Medicine Hospital of KunShan.

In this group, there was 1 case of papillary bleeding, which was stopped by 1: 10000 adrenalin submucosal injection, and there were 3 cases of pancreatitis, 2 cases of cholangitis, all of which were improved after conservative treatment of internal medicine.No patient was transferred for open surgery and no death occurred. Postoperative hospital stays were 4-10 days, with an average of (5.3±2.8) days.The mean follow-up time was 2-24 months, mean (7.5±5.1) months.No abdominal pain, jaundice or fever occurred. No recurrence of bile duct stones was observed under ultrasonography.

modified ERCP+ EST combined with LC is an effective, safe and reliable minimally invasive treatment for elderly patients with cholecystolithiasis and choledocholithiasis.