Abstract: Objective The aim of this study was to investigate the efficacy of step by step three-endoscope surgery in the treatment of patients with calculous biliary obstruction and acute cholangitis. Method In our series, 75 elderly patients with common bile duct stones and gallbladder stones and acute cholangitis were recruited in our hospital, and the emergent endoscopic retrograde cholangiopancreatography (ERCP) was performed and the elective laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) were completed thereafter in 35 patients in observation group and the emergent LC and LCBDE were done in 40 patients in control. Result The operation time in the observation group was much longer than in the control(P＜0.05), while the intraoperative bleeding was significantly less than in the control group(P<0.05); the white blood cell counts, the percentage of neutrophils, serum C-reactive protein and procalcitonin levels in the observation group were much lower than in the control (P＜0.05); 3 days after operation, serum brain natriuretic peptide(BNP) and creatine kinase in the observation were (427.0±327.0)pg/ml and (95.0±30.0)U/L, significantly lower than [(944.0±648.0)pg/ml and (149.0±67.0)U/L, respectively, P<0.05], while serum troponin T(TNT) and lactate dehydrogenase(LDH) levels were (62.8±54.5)pg/ml and (272.0±48.0)U/L, both significantly higher than [(30.5±17.1)pg/ml and (229.0±32.0)U/L, respectively, P＜0.05] in the control group. Conclusion The emergent ERCP could quickly get rid of biliary obstruction and make it possible for elective LC and LCBDE in patients with common bile duct stones and gallbladder stones and acute cholangitis, which warrants further clinical investigation.

Key words: Cholelithiasis, Acute cholangitis, Endoscopic retrograde cholangiopancreatography, Laparoscopic cholecystectomy, Laparoscopic common bile duct exploration, Therapy