目的 探讨腹腔镜胆总管切开取石术（LCBDE）一期缝合治疗胆总管结石的效果及安全性。方法 选择2022年6月—2024年5月行LCBDE治疗的220例胆总管结石患者为研究对象,按随机数字表法分为一期缝合组（124例）和T管引流组（96例）,比较两组疗效。结果 一期缝合组手术时间、术后引流时间、住院时间、术后下床活动时间、胃肠功能恢复时间显著少于T管引流组（P<0.05）;两组术中出血量比较,差异无统计学意义（P>0.05）。术前,两组间胆红素指标差异无统计学意义（P>0.05）;术后3 d,两组胆红素指标均较术前显著降低,且一期缝合组显著低于T管引流组（P<0.05）。一期缝合组并发症发生率显著低于T管引流组（P<0.05）。随访6个月,经胆道镜检查显示两组患者均未有结石复发的情况出现。结论 与T管引流相比,将一期缝合应用于腹腔镜胆总管切开取石术的临床效果更好,且安全性更高,利于患者康复。

Objective To investigate the efficacy and safety of laparoscopic common bile duct exploration （LCBDE） and primary suture in the treatment of choledocholithiasis. Methods A total of 220 patients with choledocholithiasis treated with LCBDE from June 2022 to May 2024 were selected as study subjects, and randomly divided into a primary suture group （124 cases） and a T-tube drainage group （96 cases）. The efficacy of the two groups was compared. Results The operation time, postoperative drainage time, hospital stay, postoperative ambulation time, and gastrointestinal function recovery time of the primary suture group were significantly shorter than those of the T-tube drainage group （P<0.05）. The amount of blood loss during operation was not different between the two groups （P>0.05）. Before operation, the bilirubin indexes were not different between the two groups （P>0.05）; at postoperative 3 d, the bilirubin indexs of the two groups were significantly reduced compared with before operation, and the indexes in the primary suture group were lower than those in the T-tube drainage group （P<0.05）. The complication rate of the primary suture group was significantly lower than that of the T-tube drainage group （P<0.05）. After 6 months of follow-up, no recurrence of stones was found by choledochoscopy. Conclusion Compared with T-tube drainage, the application of primary suture in LCBDE has better clinical effect and higher safety, which is conducive to the rehabilitation of patients.