目的 探讨不同胆总管直径（common bile duct diameter，CBDD）对行腹腔镜胆总管探查术（laparoscopic common bile duct exploration，LCBDE）联合一期缝合术治疗胆总管结石患者的临床疗效、安全性及术后胆道相关并发症的影响，为临床手术适应证的选择提供参考依据。 方法 回顾性分析2022年3月至2025年9月贵州医科大学第三附属医院肝胆外科收治的103例行LCBDE联合一期缝合术治疗胆总管结石患者的临床及随访资料。根据术前核磁测定以及术中测定的胆总管外径将患者分为细径组（A组，0.6 cm ≤ CBDD < 1.0 cm，n = 42）与扩张组（B组，CBDD ≥ 1.0 cm，n = 61）。对比分析两组患者的基线特征、手术相关精细指标、术后肝功能动态恢复情况及并发症发生率。 结果 两组术前基线资料差异无统计学意义（P > 0.05）。A组手术时间及术后住院时间均长于B组（P < 0.05），胆总管切口长度短于B组（P < 0.05）；两组术后第1天（POD1）、术后第3天（POD3）谷丙转氨酶（ALT）、总胆红素（TBIL）水平均较术前显著下降（P < 0.05），且组间同期比较差异无统计学意义（P > 0.05）；两组术后并发症总发生率差异无统计学意义（P > 0.05），其中A组发生胆漏3例（7.14%），B组发生2例（3.28%），均为ISGLS A级胆漏，经保守治疗痊愈，差异无统计学意义（P > 0.05）。 结论 CBDD < 1.0 cm并非一期缝合的绝对禁忌证，虽然细径胆管增加了手术难度，延长了手术时间及住院时间，但其并不阻碍术后肝功能的快速恢复，且未显著增加严重胆漏等并发症风险，临床疗效确切。

Objective To explore the influence of different common bile duct diameters （CBDD） on the clinical efficacy， safety， and postoperative biliary tract-related complications in patients with common bile duct stones who receive laparoscopic common bile duct exploration （LCBDE） combined with primary suture， aiming to provide a reference basis for the selection of clinical surgical indications. Methods The clinical and follow-up data of 103 patients with common bile duct stones who were treated with LCBDE combined with primary suture were retrospectively analyzed in the Department of Hepatobiliary Surgery of the Third Affiliated Hospital of Guizhou Medical University from March 2022 to September 2025. Based on the outer diameter of the common bile duct measured by preoperative magnetic resonance imaging （MRI） and intraoperative measurement， the patients were divided into the small-diameter group （Group A， 0.6 cm ≤ CBDD < 1.0 cm， n = 42） and the dilation group （Group B， CBDD ≥ 1.0 cm， n = 61）. The baseline characteristics， surgery-related detailed indicators， postoperative dynamic recovery of liver function， and incidence rates of complications were compared and analyzed between the two groups of patients. Results There were no statistically significant differences in preoperative baseline data between the two groups （P > 0.05）. In comparison with group B， group A had a longer surgical time and a longer postoperative hospital stay （P < 0.05）， as well as a shorter common bile duct incision length （P < 0.05）. The levels of alanine aminotransferase （ALT） and total bilirubin （TBIL） on the 1st day after surgery （POD1） and the 3rd day after surgery （POD3） in both groups decreased significantly compared to the preoperative levels （P < 0.05）， and there were no statistically significant differences between the groups at the same time-points （P > 0.05）. The overall incidence rate of postoperative complications showed no statistically significant difference between the groups （P > 0.05）. Specifically， group A had 3 cases （7.14%） of bile leakage， whereas group B had 2 cases （3.28%）. These 5 cases were classified as ISGLS grade A bile leakage and resolved with conservative treatment， with no statistically significant difference between the groups （P > 0.05）. Conclusions CBDD < 1.0 cm is not an absolute contraindication for primary suture. Although a small-diameter bile duct increases the difficulty of surgery， prolongs the surgical time， and extends the hospital stay， it does not impede the rapid recovery of postoperative liver function and does not significantly increase the risk of complications such as severe bile leakage， with definite clinical efficacy.