连续与间断缝合在腹腔镜胆总管切开一期缝合术中的临床效果观察  

Clinical effect of primary suture after laparoscopic choledocholithotomy with continuous and intermittent suture

作　　者：王新伟[1] 孙坤举 孟晓敏 徐昕阳 李艺 WANG Xinwei;SUN Kunju;MENG Xiaomin(Department of Hepatobiliary Surgery,Rizhao Municipal Hospital of Traditional Chinese Medicine,Rizhao 276800,China;Shandong University of Traditional Chinese Medicine)

机构地区：[1]日照市中医医院肝胆胰脾外科,山东日照276800 [2]山东中医药大学

出　　处：《腹腔镜外科杂志》2023年第11期832-835,850,共5页Journal of Laparoscopic Surgery

基　　金：第五批全国中医临床优秀人才研修项目【国中医药人教函[2022]1号】。

摘　　要：目的:探讨腹腔镜联合胆道镜下使用倒刺线连续缝合与传统3-0可吸收线间断缝合在胆总管切开术后一期缝合中的应用效果。方法:回顾分析2020年1月至2022年12月由同一手术团队为49例胆囊结石合并胆总管结石患者行腹腔镜联合胆道镜胆囊切除、胆总管切开探查取石、一期缝合术的临床资料,其中28例采用倒刺线连续缝合胆总管切口(连续缝合组),21例采用传统3-0可吸收缝线间断缝合胆总管切口(间断缝合组)。比较两组手术时间、术中胆总管缝合时间、术中出血量、术后住院时间、术后引流管留置时间、术中及术后胆漏发生率。结果:两组患者一般资料、术中出血量、术中胆漏发生率、术后住院时间差异无统计学意义(P>0.05);连续缝合组术中胆总管缝合时间[(8.11±2.03)min vs.(10.10±2.55)min]、总手术时间[(121.18±29.03)min vs.(147.14±47.15)min]、术后引流管留置时间[(69.68±10.72)h vs.(78.29±15.07)h]均短于间断缝合组(P<0.05)。结论:相较传统3-0可吸收缝线间断缝合,腹腔镜联合胆道镜胆总管切开取石、一期缝合术中使用倒刺线连续缝合具有缩短手术时间、提高手术效率的优势,且不增加手术并发症,值得临床推广应用。Objective:To investigate the application effect of continuous suture with barbed thread and intermittent suture with traditional 3-0 absorbable thread in laparoscopic combined with choledochoscopic primary suture after choledocholithotomy.Methods:The clinical data of 49 patients,who suffered from cholecystolithiasis and choledocholithiasis and underwent laparoscopic combined with choledochoscopic cholecystectomy,choledochotomy and primary suture from Jan.2020 to Dec.2022,were reviewed and analyzed.Among them,28 patients underwent continuous suture of common bile duct with barbed thread(continuous suture group)and 21 cases underwent intermittent suture with traditional 3-0 absorbable thread(intermittent suture group).The operation time,suture time of the common bile duct,intraoperative blood loss,postoperative hospital stay,postoperative drainage tube retention time,intraoperative and post-operative bile leakage between the two groups were compared.Results:There were no significant differences between the two groups in general information,intraoperative blood loss,intraoperative bile leakage rate and postoperative hospital stay(P>0.05).The duration of choledochal suture[(8.11±2.03)min vs.(10.10±2.55)min],total operation time[(121.18±29.03)min vs.(147.14±47.15)min]and postoperative drainage tube retention time[(69.68±10.72)h vs.(78.29±15.07)h]in the continuous suture group were significantly shorter than those in the intermittent suture group(P<0.05).Conclusions:Compared with traditional intermittent suture with 3-0 absorbable thread,continuous suture with barbed thread has the advantage of shortening surgical time,improving surgical efficiency,and not increasing surgical complications in laparoscopic combined choledochoscopic choledochotomy and primary suture,which is w orthy of promotion and application in clinical practice.

关 键 词：胆总管结石病 胆囊结石病 腹腔镜检查 胆道镜检查 一期缝合 

分 类 号：R657.4[医药卫生—外科学]