摘要目的:比较腹腔镜胆总管探查取石术后一期缝合与T管引流治疗胆总管结石的疗效。方法:选择贵州医科大学第二附属医院2021年2月至2023年2月收治的胆总管结石患者52例为研究对象，均行腹腔镜胆总管探查取石术，采用随机对照（RCT）研究方法，以随机数字表法将患者分成两组，各26例，对照组术后行T管引流进行治疗，观察组术后行一期缝合进行治疗；两组术后均观察3 d，比较两组术后临床指标、血清皮质醇、肾上腺素、C反应蛋白（CRP）、白细胞介素6（IL-6）、血清直接胆红素（DBIL）、总胆汁酸（TBA）、碱性磷酸酶（ALP）、谷氨酰转肽酶（GGT）、术后并发症发生情况。结果:观察组手术时间为（105.30±5.89）min，显著短于对照组的（121.36±5.86）min（ t=9.86， P < 0.001）；观察组术中出血量为（40.31±4.53）mL，少于对照组的（45.20±4.76）mL（ t=3.80， P < 0.001）；观察组住院时间为（12.01±2.86）d，短于对照组的（14.32±2.73）d（ t=2.98， P=0.005）；观察组胃肠功能恢复时间为（31.42±2.59）d，快于对照组的（37.62±2.63）d（ t=8.57， P < 0.001）；观察组胆汁引流量为（168.69±15.41）mL，少于对照组的（275.62±15.32）mL（ t=25.09， P < 0.001）。两组应激指标（术后）比较：观察组皮质醇为（469.63±20.62）mmol/L，高于对照组的（359.65±19.87）mmol/L（ t=19.58， P < 0.001）；观察组肾上腺素为（274.62±20.21）ng/L，高于对照组的（198.64±20.16）ng/L（ t=13.57， P < 0.001）；观察组CRP为（3.42±0.37）mg/L，高于对照组的（2.74±0.25）mg/L（ t=7.77， P < 0.001）；观察组IL-6（112.36±8.94）μg/L，高于对照组的（87.62±8.63）μg/L（ t=10.15， P < 0.001）。两组肝功能指标（术后）比较：观察组DBIL为（24.52±4.62）μmol/L，低于对照组的（35.62±4.87）μmol/L（ t=8.43， P < 0.001）；观察组TBA为（10.62±4.21）U/L，低于对照组的（17.64±4.16）U/L（ t=6.05， P < 0.001）。观察组ALP为（100.21±10.24）mg/L，低于对照组的（112.74±11.25）mg/L（ t=4.20， P < 0.001）；观察组GGT为（122.36±8.94）μg/L，低于对照组的（142.62±5.63）μg/L（ t=9.78， P < 0.001）。两组并发症发生率比较：观察组［7.69%（2/26）］显著低于对照组［30.77%（8/26）］（χ 2=4.46， P=0.035）。 结论:与T管引流相比较，腹腔镜胆总管探查取石术后一期缝合可以减轻患者应激反应，改善肝功能，术后恢复时间短，且并发症发生率更低。

abstractsObjective:To investigate the efficacy of primary closure versus T-tube drainage in patients with common bile duct stones after laparoscopic common bile duct exploration and stone extraction. Methods:Fifty-two patients with common bile duct stones who received treatment at The Second Affiliated Hospital of Guizhou Medical University between February 2021 and February 2023 were included in this study. All patients underwent laparoscopic common bile duct exploration and stone extraction and then were divided into two groups ( n = 26 per group) using a randomized controlled trial design with allocation based on a random number table. The control group received T-tube drainage postoperatively, whereas the observation group underwent primary suture treatment. Both groups were observed for 3 days postoperatively to compare various postoperative clinical indicators, including serum levels of cortisol, adrenaline, C-reactive protein, interleukin-6, direct bilirubin, total bile acid, alkaline phosphatase, and gamma-glutamyl transferase, and the occurrence of postoperative complications. Results:The operative time in the observation group was significantly shorter than that in the control group [(105.30 ± 5.89) minutes vs. (121.36 ± 5.86) minutes, t = 9.86, P < 0.001]. The intraoperative blood loss in the observation group was significantly less than that in the control group [(40.31 ± 4.53) mL vs. (45.20 ± 4.76) mL, t = 3.80, P < 0.001]. The length of hospital stay in the observation group was significantly shorter than that in the control group [(12.01 ± 2.86) days vs. (14.32 ± 2.73) days, t = 2.98, P = 0.005]. The gastrointestinal function recovery time in the observation group was shorter than that in the control group [(31.42 ± 2.59) days vs. (37.62 ± 2.63) days, t = 8.57, P < 0.001]. The bile drainage volume in the observation group was less than that in the control group [(168.69 ± 15.41) mL vs. (275.62 ± 15.32) mL, t = 25.09, P < 0.001]. The serum level of cortisol in the observation group was significantly higher than that in the control group [(469.63 ± 20.62) mmol/L vs. (359.65 ± 19.87) mmol/L, t = 19.58, P < 0.001]. The serum level of adrenaline in the observation group was significantly higher than that in the control group [(274.62 ± 20.21) ng/L vs. (198.64 ± 20.16) ng/L, t = 13.57, P < 0.001]. The serum level of C-reactive protein in the observation group was significantly higher than that in the control group [(3.42 ± 0.37) mg/L vs. (2.74 ± 0.25) mg/L, t = 7.77, P < 0.001]. The serum level of interleukin-6 in the observation group was significantly higher than that in the control group [(112.36 ± 8.94) μg/L vs. (87.62 ± 8.63) μg/L, t = 10.15, P < 0.001]. The serum level of direct bilirubin in the observation group was significantly lower than that in the control group [(24.52 ± 4.62) μmol/L vs. (35.62 ± 4.87) μmol/L, t = 8.43, P < 0.001]. The serum level of total bile acid in the observation group was significantly lower than that in the control group [(10.62 ± 4.21) U/L vs. (17.64 ± 4.16) U/L, t = 6.05, P < 0.001]. The serum level of alkaline phosphatase in the observation group was significantly lower than that in the control group [(100.21 ± 10.24) mg/L vs. (112.74 ± 11.25) mg/L, t = 4.20, P < 0.001]. The serum level of gamma-glutamyl transferase in the observation group was significantly lower than that in the control group [(122.36 ± 8.94) μg/L vs. (142.62 ± 5.63) μg/L, t = 9.78, P < 0.001]. The incidence of complications in the observation group was significantly lower than that in the control group [7.69% (2/26) vs. 30.77% (8/26), χ2 = 4.46, P = 0.035]. Conclusion:Compared with T-tube drainage, primary closure following laparoscopic common bile duct exploration and stone extraction can reduce patient stress responses, improve liver function, shorten postoperative recovery time, and result in a lower incidence of complications.