To explore the clinical efficacy and impact on patient prognosis of laparoscopic common bile duct exploration and stone removal (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of common bile duct middle and lower segment stones combined with acute cholangitis.

The clinical data of 113 patients with common bile duct middle and lower segment stones combined with acute cholangitis from January 2023 to December 2024 were retrospectively analyzed. The patients were divided into the LCBDE group (treated with LCBDE) and the ERCP group (treated with ERCP) based on the surgical method. Fifty-four patients were selected from each group using the propensity score matching method. Statistical analysis was performed using SPSS 28.0 software to process the data. The Mann-Whitney U test, χ² or t test were used. P<0.05 was considered statistically significant.

The stone clearance rates in the LCBDE group and the ERCP group were 94.4% and 88.9%, respectively, with no statistically significant difference (P>0.05). The operation time, intraoperative blood loss, postoperative defecation time, recovery activity time and hospital stay of the ERCP group were shorter than those of the LCBDE group (P<0.05). On the 3rd day after surgery, the levels of C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), heparin-binding protein (HBP), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and bilirubin (TBIL) in both groups were lower than those before surgery (P<0.05), but there was no statistically significant difference between the two groups (P>0.05). The total incidence of postoperative complications between the two groups was not statistically significant (P>0.05).

LCBDE and ERCP have comparable efficacy and safety in the treatment of common bile duct middle and lower segment stones combined with acute cholangitis, and ERCP has more advantages in shortening the perioperative period and reducing intraoperative bleeding.