倒刺线全层连续外翻缝合在腹腔镜胆总管探查一期缝合中的应用  

Application of full-thickness continuous eversion suture with barbed wire in primary suture of laparoscopic choledocholithotomy

作　　者：缪小飞 周雄 王彤 MIAO Xiao-fei;ZHOU Xiong;WANG Tong(Department of Endoscopic Surgery,Wuxi People's Hospital Affiliated to Nanjing Medical U niversity,Wuxi 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院腔镜外科,江苏无锡214023

出　　处：《腹腔镜外科杂志》2022年第10期779-782,共4页Journal of Laparoscopic Surgery

基　　金：国家自然科学基金(81371683)。

摘　　要：目的:分析倒刺线全层连续外翻缝合在腹腔镜胆总管切开取石一期缝合术中的应用价值。方法:回顾分析2018年10月至2021年12月收治的50例胆总管结石合并胆囊结石患者的临床资料,其中男35例,女15例,平均(62.5±15.9)岁;均行腹腔镜胆囊切除、胆总管切开取石一期缝合术,术中采用倒刺线全层连续外翻缝合胆总管探查切口。分析患者手术时间、术中出血量、术中胆漏及术后胆漏、出血、腹腔感染等情况,出院后随访复发、胆总管狭窄情况。结果:50例患者均顺利完成胆总管探查一期缝合术,手术时间平均(77.5±20.2)min,术中出血量平均(43.0±40.1)mL。术中胆漏2例(4%),术后胆漏2例(4%),无腹腔或胆道出血、胆管炎、腹腔感染等并发症发生。50例患者均获得随访,随访时间3~42个月,1例(2%)胆总管结石复发行内镜逆行胰胆管造影+乳头括约肌切开取石术;均无胆管狭窄或急性胆管炎发生。结论:倒刺线全层连续外翻缝合在腹腔镜胆总管探查一期缝合术中是安全、可靠的,具有一定的临床优势。Objective:To study the application value of full-thickness continuous eversion suture with barbed wire in the p rimary suture of laparoscopic choledocholithotomy.Methods:The clinical data of 50 patients with choledocholithiasis complicated with cholecystolithiasis who underwent laparoscopic cholecystectomy,choledocholithotomy and one-stage suture from Oct.2018 to Dec.2021 were retrospectively analyzed.There were 35 males and 15 females aged(62.5±15.9)years.Fifty patients underwent full-layer continuous eversion suture of common bile duct incision with barbed wire.The operation time,intraoperative blood loss and bile leakage,p ostoperative bile leakage,bleeding and abdominal infection were analyzed.After discharge,the patients were mainly followed up for r ecurrence of common bile duct stones and common bile duct stenosis.Results:All 50 patients successfully completed the common bile duct exploration and p rimary suture.The operation time was(77.5±20.2)min and the intraoperative bleeding was(43.0±40.1)mL.Bile leakage was found in 2 cases(4%)during operation and 2 cases(4%)after operation.There were no abdominal or biliary b leeding,cholangitis and abdominal infection.All 50 patients were followed up for 3-42 months.One patient(2%)received endoscopic retrograde cholangiopancreatography and sphincterotomy after the recurrence of choledocholithiasis.All patients had no bile duct stenosis or acute cholangitis.Conclusions:The application of full-thickness continuous eversion suture with barbed wire in the primary suture of laparoscopic common bile duct exploration is safe and reliable,and has certain clinical advantages.

关 键 词：胆总管结石病 胆总管探查取石术 一期缝合 腹腔镜检查 倒刺线 

分 类 号：R657.4[医药卫生—外科学]