腹腔镜胆总管一期分层缝合减少术后胆漏的临床观察

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英文篇名：Clinical observation of laparoscopic primary layered suture of common bile duct to reduce postoperative bile leakage 作者：毛海香 ; 朱杰 ; 张斌 ; 王海彪 英文作者：MAO Hai-xiang;ZHU Jie;ZHANG Bin;WANG Hai-biao;Department of Hepatobiliary Surgery, Ningbo Medical Centre Lihuili Hospital; 关键词：胆囊切除术 ; 腹腔镜 ; 胆总管切开取石 ; 一期缝合 ; 分层缝合 ; 单纯缝合 ; 胆漏 英文关键词：laparoscopic cholecystectomy;;choledocholithotomy;;primary suture;;layered suture;;single-layer suture;;bile lakage 中文刊名：GDYW 英文刊名：Journal of Hepatopancreatobiliary Surgery 机构：宁波市医疗中心李惠利医院肝胆外科; 出版日期：2019-02-15 出版单位：肝胆胰外科杂志 年：2019 期：v.31 语种：中文; 页：GDYW201902006 页数：4 CN：02 ISSN：33-1196/R 分类号：22-24+39

摘要

目的探讨分层缝合技术在两孔腹腔镜胆囊切除术+胆总管切开取石术中的应用价值。方法 2014年8月至2017年8月,对宁波市医疗中心李惠利医院267例胆总管结石患者施行两孔腹腔镜胆囊切除术+胆总管切开取石术,并进行前瞻性研究。267例中,110例采用分层缝合技术,157例采用单层缝合技术。比较两组手术时间、术后住院时间和术后并发症。结果两组均顺利完成手术,无一例中转开腹。两组手术时间没有明显差异(t=-0.587,P=0.086)。分层缝合组术后住院时间和术后胆漏的发生率明显低于单层缝合组[(7.6±1.8)d vs (5.8±1.7)d,t=2.776,P<0.001;4.5%(5/110) vs 20.4%(32/157),χ~2=13.590,P<0.001]。在单层缝合组中,合并急性胆管炎患者的术后胆漏率明显高于无急性胆管炎患者[44.4%(12/27)vs 15.4%(20/130),χ~2=11.634,P=0.001];在分层缝合组中,有无重症胆管炎对患者术后胆漏的发生率不存在明显影响[11.8%(2/17) vs 3.2%(3/93),χ~2=0.848,P=0.357]。结论采用分层缝合技术在两孔腹腔镜胆囊切除术+胆总管切开取石术中是可行且安全的,其优点是减少了胆管的渗漏,缩短了住院时间。
        Objective To explore the application value of layered suture technique in two-port laparoscopic cholecystectomy+choledocholithotomy. Methods A prospective study was conducted in 267 patients who received two-port laparoscopic cholecystectomy+choledocholithotomy with primary suture in Ningbo Medical Centre Lihuili Hospital between Aug. 2014 and Aug. 2017. Layered suture technique was used in 110 patients and single-layer suture technique in 157 patients. The operation time, postoperative hospitalization time, and postoperative complications were compared between the two groups. Results Patients were all operated smoothly, with no conversation to laparotomy. The operation time was not significantly different between the two groups(t=-0.587, P=0.086). The postoperative hospitalization time and incidence of postoperative bile leakage were significantly lower in layered suture group than those in single-layer suture group [(7.6±1.8)d vs(5.8±1.7)d, t=2.776, P ≤ 0.001; 4.5%(5/110) vs 20.4%(32/157), χ~2=13.590, P<0.001]. In the single-layer suture group, the incidence of postoperative bile leakage was significantly higher in patients complicated with acute cholangitis [44.4%(12/27) vs 15.4%(20/130), χ~2=11.634, P=0.001], whereas in the layered suture group, the incidence of postoperative bile leakage was not significantly different between patients with and without acute cholangitis [11.8%(2/17) vs 3.2%(3/93), χ~2=0.848, P=0.357]. Conclusion Application of layered suture technique in twoport laparoscopic cholecytectomy+choledocholithotomy with primary suture is feasible and safe, with advantages of lower bile leakage incidence and shorter hospitalization time.

引文

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