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目的 探讨腹腔镜胆总管探查(LCBDE)一期缝合术后发生胆漏的危险因素.方法 LCBDE一期缝合的患者154例.胆漏的危险因素采用Logistic回归分析,包括人口统计学因素,术前状况和术中操作.结果 行LCBDE手术308例,其中154例行一期缝合.154例患者中胆漏发生率为11.7％ (18/154).胆漏好发于拥有纤细胆总管(直径＜1 cm和直径≥1 cm胆漏发生率分别为33.3％和8.0％,P＜0.05)和术者经验较少的患者(初始70例和70例后接受手术的患者胆漏发生率分别为17.1％和7.1％,P＜0.05).经过多变量回归分析,纤细胆总管[OR 95％ CI,4.216(1.042 ～ 14.528),P＜0.05]和缺乏经验的术者[OR 95％ CI,4.136(1.286～ 13.251),P＜0.05]对胆漏的发生存在影响.结论 纤细的胆总管和缺乏经验的术者是LCBDE一期缝合术后发生胆漏的独立危险因素.“,”Objective The purpose of this study was to investigate the risk factors of bile leakage after primary closure of common bile duct (CBD) in LCBDE.Methods A retrospective cohort study of 154 patients who underwent LCBDE with primary closure.The risk factors for bile leakage were analyzed by Logistic regression analysis,including demographic factors.preoperative condition and operation.Results 308 LCBDE procedures were applied in our hospital and 154 patients with primary closure were included in this study.Among the 154 patients,the incidence of bile leakage was 11.7％ (18/154).Bile leakage occurred more frequently in patients with slender CBD(＜ 1 vs ≥ 1 cm,33.3％ vs 8.0％,P ＜ 0.05) and those managed by inexperienced surgeons (initial 70 cases vs later cases,17.1％ vs 7.1％,P ＜ 0.05).After multivariable regression,slender CBD [OR 95％ CI,4.216 (1.042 ～ 14.528),P ＜ 0.05] and inexperienced surgeons [OR 95％ CI,4.136 (1.286 ～ 13.251),P ＜ 0.05] were found to affect bile leakage(most significantly).Conclusion Slender CBD and inexperienced surgeons were associated with high risk of bile leakage independently after primary closure following LCBDE.