摘要
目的探讨连续缝合和间断缝合在腹腔镜胆总管探查一期缝合术治疗老年胆总管结石中的操作技巧和临床疗效。方法回顾性分析2020年1月至2023年1月我院肝胆中心应用腹腔镜胆总管探查一期缝合术治疗的276例老年胆总管结石病人的临床资料,其中181例行胆总管倒刺线连续缝合(连续缝合组),95例行胆总管薇乔线间断缝合(间断缝合组)。比较2组一般资料、围手术期相关指标及术后并发症发生情况。结果所有病人均顺利完成腹腔镜手术,无中转手术病例。2组一般资料、胆总管直径、胆总管管壁厚度、结石直径差异均无统计学意义(P>0.05)。但连续缝合组在手术时间、胆管缝合时间、术中出血量方面明显优于间断缝合组(P<0.05或P<0.01)。术后共7例病人发生胆漏,均通过保持腹腔持续引流顺利恢复,无再次手术病例,但连续缝合组胆漏发生率明显低于间断缝合组(1.1%比5.3%,P=0.037)。随访3~24个月,2组结石残留、结石复发率差异均无统计学意义(P>0.05)。结论对于老年胆总管结石病人,相较于间断缝合,应用连续缝合的腹腔镜胆总管探查一期缝合术能够缩短手术时间,减少手术并发症,加快术后康复,是一种有效且安全的微创手术方法。
Objective To explore the operation skills and clinical effects of continous suture and intermittent snture for laparoscopic common bile duct exploration with primary suture in the treatment of elderly patients with common bile duct stones.Methods The clinical data of 276 elderly patients with common bile duct stones treated by laparoscopic common bile duct exploration with primary suture in our center from January 2020 to January 2023 were retrospectively analyzed,including 181 cases of continuous suture with barb suture(continuous suture group)and 95 cases of intermittent suture with vicryl suture(intermittent suture group).The general data,perioperative related indexes and the incidence of postoperative complications were compared between the two groups.Results All laparoscopic surgery had been successfully completed,without any case of conversion.There were no statistical differences in general data,the diameter of common bile duct,the thickness of common bile duct wall and the diameter of stones between the two groups(P>0.05).The operation time,the time of bile duct suture and operation bleeding volume in continuous suture group were better than those in intermittent suture group(P<0.05 or P<0.01).Seven cases with bile leakage were recovered by continuous drainage,but the incidence rate of bile leakage in continuous suture group was less than that in intermittent suture group(1.1%vs 5.3%,P=0.037).After 3-24 months of follow-up,there were no significant differences in the residual rate of stone and recurrence rate of cholecystolithias between the two groups.Conclusions Compared with intermittent suture,laparoscopic common bile duct exploration with primary suture by continuous suture is an effective and safe minimally invasive surgery for the elderly patients with common bile duct stones,which can shorten the operation time,reduce the complications,and accelerate the postoperative recovery.
作者
胡元昌
石毅
白剑峰
高骥
HU Yuanchang;SHI Yi;BAI Jianfeng;GAO Ji(Hepatobiliary Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)
出处
《实用老年医学》
CAS
2024年第6期621-624,共4页
Practical Geriatrics
关键词
胆总管结石
一期缝合
连续缝合
间断缝合
老年人
common bile duct stone
primary suture
continuous suture
intermittent suture
aged
