Compare the prognostic effects of laparoscopic common bile duct exploration with "T" tube drainage (LCBDE) and laparoscopic common bile duct exploration and stone extraction via cystic duct (LTCBDE) in patients with secondary common bile duct stones.

A total of 116 patients with secondary common bile duct stones admitted to our hospital from February 2020 to February 2023 were selected as the research subjects. According to the surgical methods, the patients were categorized into the LTCBDE group (n=57) and the LCBDE group (n=59). The propensity score matching method was used to balance the differences between the two groups. After reducing the potential confounding factors, the basic data, perioperative indicators, stress indicators and complications of the two groups of patients were analyzed by t test, χ² test or Fisher's exact probability test. P<0.05 was considered statistically significant.

After matching, there were statistically significant differences between the two groups in postoperative drainage time, postoperative 24 h visual analogue scale score, postoperative fluid infusion volume, incision length, postoperative hospital stay, gastrointestinal function recovery time, intraoperative blood loss, return to normal life time, operation time, anal exhaust recovery time (P<0.05). Three days after surgery, the levels of interleukin-6 (IL-6) in the two groups were lower than those before surgery (P<0.05), and the levels of adrenocorticotropic hormone (ACTH), cortisol (Cor), natural killer cell (NK) and norepinephrine (NE) in the two groups were higher than those before surgery (P<0.05). However, the levels of IL-6, ACTH, Cor, NK and NE in LTCBDE group were lower than those in LCBDE group (P<0.05). The total incidence of complications in LCBDE group was higher than that in LTCBDE group, and the difference was statistically significant (P< 0.05). There was no significant difference in recurrence rate between LTCBDE group and LCBDE group (25.0% vs. 27.8%) (χ²=0.071, P=0.789).

Compared with LCBDE, LTCBDE has advantages such as low stress response and low complication rate. This study more strongly recommends LTCBDE for the treatment of secondary common bile duct stones.