关键词: 胆总管结石, 腹腔镜, 十二指肠镜

Abstract: Objective To investigate the clinical efficacy and pros and cons of laparoscopic primary closure of common bile duct in patients with choledocholith-iasis by three endoscopes(laparoscopy + choledochoscopy + duodenoscope). 
Methods The clinical data of 123 patients with common bile duct stones who underwent choledocholithotomy  were collected by retrospectively analysis method. Among the 123 cases, 62 cases(50.4%) underwent combination appliances of three endoscopes combined with choledocholithotomy and nasobiliary drainage through abdomen and primary closure of common bile duct，and hereinafter referred to as the three-endoscopes group. And 61 cases(49.6%) underwent choledocholithotomy plus T-tube drainage, and hereinafter referred to as the T-tube group. With observation on the general conditions before operation, situations at surgery, postoperative recovery situations and complications and follow-up situations of patients, we had a contrastive analysis of the pros and cons of primary suture of common bile duct with three endoscopes and T-tube drainage after choledocholithotomy. 
Results The differences of gender, age, preoperative with acute pancreatitis, preoperative chronic disease rate (hypertension, diabetes, heart disease), the number of stones, operation time, nasobiliary and T-tube drainage volume on the first day after operation, postoperative removal of abdominal drainage tube time, the rate of postoperative bile leakage, the postoperative hemorrhage, and the rate of complications of postoperative pancreatitis and hospitalization cost of patients all had no statistics significance(P＞0.05) between the three-endoscopes group and the T-tube group. But the differences of common bile duct diameter, preoperative total bilirubin, severe degrees of preoperative cholangitis(According to the 2018 version of the Tokyo Guideline classification), previous history of upper abdominal surgery, the estimated intraoperative bleeding volume, the size of stone, the abdominal drainage volume on the 1st postoperative day, the rate of postoperative residual stone, the cost of surgical treatment, and the hospitalization time of patients had statistics significance(P＜0.05) between the three-endoscopes group and the T-tube group. All 140 cases underwent operations successfully and recovered well. There were no stone recurrence, biliary stricture or other related complications occurred during the follow-up period.  
Conclusion With the support of reliable endoscopic suture technique, the laparoscopic primary suture of common bile duct with three endoscopes is safe and feasible, and the clinical effect is satisfactory. However, we should not blindly choose primary suture. Individualized surgical treatment should be formulated according to the patient′s own conditions and the advantages and disadvantages of different surgical.

Key words: choledocholithiasis, laparoscopy, duodenoscopes