Objective To summarize the experience of applying choledochoscopy, duodenoscopy and laparoscopy, one-stage suturing of common bile duct, to treat cholecystolithiasis and choledocholithiasis that failed to respond to ordinary endoscopic sphincterotomy (EST). Methods Retrospectively analyzed the clinical data of twenty-five pa-tients with choledocholithiasis complicated with cholecystolithiasis. 25 cases of failure to endoscopic stone extraction underwent LC and laparoscopic common bile duct exploration with primary suture of (BD) from June 2013 to June 2015. Results One patient was converted to laparotomy with small incision. The other one had residual stones and therefore underwent a second EST. After the treatment, two patients developed hyperamylasemia, which was cured by conservative therapy; One patient had bile leakage, which was treated by percutaneous drainage with no serious complications and death. No long-term complication was found in a portion of patients followed up until now. Conclusion In properly selected patients of duodenoscopy management-failed, synchronous treatment of combined application of three endoscopies in laparoscopic surgery with primary suture of (BD) is feasible, effective and safe.

Objective To explore the clinical efficary of modified four-step laparoscopic splenec-tomy and pericardial devascularization.Methods The clinical data of 72 patients with portal hypertension who were admitted to our hospital were retrospectively analyzed.Patients were divided into modified four-step laparoscopic group(36 patients)and open group(36 patients). The clinical indicators(operation time,amount of intraoperative blood loss,hospital stay,total hospitalization expenses,and intraoperative bleeding rate)and the incidence of postoperative complications were compared among the two groups.Re-sults The intraoperative blood loss(755.16 ± 50.23),Intraoperative bleeding rate(13%)and hospital stay(14.77 ± 2.09)of open group was higher than the modified four-step laparoscopic group(462.02 ± 61.42,11.11%,9.45 ± 3.20,P<0.05).The median operation time(187.67 ± 32.10)and the cost of hospitalization(42368. 70)of open group was lower than the modified four-step laparoscopic group (265.79 ± 48.23,50143.46,P<0.05).There were no significant differences in perioperative complica-tion rate among the two groups(P>0.05).Conclusions The procedure of modified four-step laparo-scopic splenectomy and pericardial devascularization has safe,feasible and with good therapeutic effect.It can significantly reduce the blood flow and blood transfusion in patients with probability,shorten the hospi-talization,lower the incidence of postoperative complications to some extent.However,the cost of hospital-ization and the time of operation are still relatively high,and further improvement should be made on the clinical application.