吸收倒刺线在双镜联合保胆取石术中的临床应用  

Clinical application of absorbable barbs line in gallbladder-protected lithotomy by laparoscopy combined with choledochoscopy

作　　者：李婧伊[1] 刘飞[1] 马跃峰[1] 祁春春 史力军[1] Jing-yi Li;Fei Liu;Yue-feng Ma;Chun-chun Qi;Li-jun Shi(Department of Minimally Invasive Surgery for Cholelithiasis,The Affiliated Zhongshan Hospital of Dalian University,Dalian,Liaoning 116001,China)

机构地区：[1]大连大学附属中山医院胆石病微创外科

出　　处：《中国现代医学杂志》2020年第2期85-89,共5页China Journal of Modern Medicine

摘　　要：目的探讨可吸收倒刺线在腹腔镜联合胆道镜(以下简称双镜联合)保胆取石术中的临床应用。方法回顾性分析2015年6月-2018年1月在大连大学附属中山医院胆石病微创外科成功行双镜联合保胆取石手术治疗的209例患者临床资料。其中,128例采用可吸收倒刺线缝合胆囊者作为倒刺线组,81例采用普通可吸收缝线者作为普通组。结果两组基线资料比较,差异无统计学意义(P>0.05)。两组术中出血量、住院时间比较,差异无统计学意义(P>0.05)。倒刺线组胆囊缝合时间(5.52±1.32)min、手术时间(64.87±16.36)min低于普通组胆囊缝合时间(6.19±1.64)min、手术时间(72.80±25.09)min(P<0.05)。倒刺线组无术后胆漏,普通组术后胆漏发生率为6.17%(P <0.05)。3例术后胆漏在积极保守治疗后缓解,2例在行内镜下鼻胆管引流治疗后缓解。术后随访3~6个月,结石复发13例,6例给予腹腔镜下胆囊切除;7例行内镜下乳头括约肌切开/内镜下乳头括约肌球囊扩张+鼻胆管引流等治疗。无死亡病例。结论可吸收倒刺线用于双镜联合保胆取石术中一期缝合胆囊安全可行,其可降低腹腔镜下胆囊缝合难度、缩短胆囊缝合时间及手术时间,降低术后胆漏发生率,临床优势明显。Objective To investigate the clinical application of absorbable barbs line in gallbladder-protected lithotomy by laparoscopy combined with choledochoscopy. Methods A retrospective analysis was used to analyze the clinical data of 209 patients treated with gallbladder-protected lithotomy by laparoscopy combined with choledochoscopy in our department from June 2015 to January 2018. Among them, the patients whose gallbladders were sutured with absorbable barbs line were enrolled in barbs line group, and patients whose gallbladders were sutured with common absorbable line were enrolled in control group. Results Among 209 patients, the barbs line group contained 128 cases, the control group contained 81 cases. There was no significant difference in general baseline data between the two groups(P > 0.05). There was no significant difference in intraoperative bleeding volume and average hospitalization time between the two groups(P > 0.05). In barbs line group, the suturing gallbladder time was(5.52 ± 1.32) min, and the operation time was(64.87 ± 16.36) min;in control group, the suture gallbladder time was(6.19 ± 1.64) min, and the operation time was(72.80 ± 25.09) min;and both time in the barbs line group was significantly less than the control group(P < 0.05). In barbs line group, there was no bile leakage occurred, but the incidence of bile leakage was 6.17%(5/81) in control group. There was a significant difference between the two groups(P < 0.05). Three cases of bile leakage were relieved after conservative treatment, and two cases were relieved after endoscopic nasobiliary drainage. The follow-up period was 3-6 months. Stone recurrence happened in 13 cases. Then 6 cases underwent laparoscopic cholecystectomy and other 7 patients of sludge stones underwent endoscopic sphincterotomy/endoscopic papillary balloon dilatation plus endoscopic nasobiliary drainage, then the sludge stones disappeared. There were no death related to operation. Conclusion It is safe and feasible to use absorbable barbs line to suture gall

关 键 词：胆结石 腹腔镜检查 治疗结果 随访研究 

分 类 号：R657.4[医药卫生—外科学]