连续返回式缝合与间断缝合在腹腔镜胆总管一期缝合中的疗效对比

Efficacy of continuous backtracking suture and intermittent suture in primary suture of laparoscopic common bile duct exploration

目的分析连续返回式缝合与间断缝合在腹腔镜胆总管一期缝合中的疗效对比.方法采用回顾性病例对照研究方法.收集2021年1月—2023年3月于南京医科大学附属常州第二人民医院行腹腔镜胆总管探查术一期缝合的胆囊结石合并胆总管结石患者68例.根据缝合方式将其分为2个组.两组术前准备相同,按照手术标准流程,完成腹腔镜下胆囊切除+胆总管探查术一期缝合.确认无结石残留后,一组采用间断缝合方式(n=36例);另一组采用连续返回式缝合方式(n=32例).对比两组各项恢复指标和手术相关并发症.结果两组在术中出血量和首次排气时间上,无统计学差异(P>0.05),间断缝合组手术时间[(117.24±17.16)vs.(101.67±13.20)min]、腹腔引流时间[(8.14±2.29)vs.(6.75±1.87)d]及住院时间[(10.51±2.74)vs.(8.49±2.50)d],均高于连续缝合组,差异有统计学意义(P<0.05).两组在腹腔残余感染、电解质紊乱及腹腔出血上,无统计学差异(P>0.05);间断缝合组胆漏的发生率高于连续缝合组(16.67%vs.3.12%),差异有统计学意义(P<0.05).结论与间断缝合相比,连续返回式缝合有助于提高腹腔镜胆总管探查术一期缝合效果,缩短手术恢复时间,并且可减少胆漏的发生,是一种安全有效的缝合方式.

Objective To analyze the differences in efficacy of continuous backtracking suture and intermittent suture in primary suture of laparoscopic common bile duct exploration.Methods A retrospective case-control study was conducted.68 patients with cholecystolithiasis combined with choledocholithiasis who were admitted to the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University between January 2021 and March 2023 were collected.They were randomly divided into two groups.All patients underwent the same preoperative preparation,laparoscopic cholecystectomy and bile duct exploration according to the standard procedure.After confirming no stone residue,one group accepted intermittent suture method(n=36 cases),and the other group accepted continuous return suture method(n=32 cases).Observation records were made in the two groups to compare various recovery indicators and surgical complications.Results Operations were successfully carried out in all patients.There were no significant differences in intraoperative blood loss and first exhaust time between the two groups(P>0.05).The operation time[(117.24±17.16)vs.(101.67±13.20)min],abdominal drainage time[(8.14±2.29)vs.(6.75±1.87)d]and hospital stay[(10.51±2.74)vs.(8.49±2.50)d]in the intermittent suture group were all higher than those in the continuous suture group with statistical significance(P<0.05).There were no significant differences in abdominal residual infection,electrolyte disturbance and abdominal bleeding between the two groups(P>0.05).The incidence of biliary leakage in the intermittent suture group was higher than that in the continuous suture group(16.67%vs.3.12%),which was statistically significant(P<0.05).Conclusion Compared with intermittent suture,continuous backtracking suture is a safe and effective way to improve the first-stage suture effect of laparoscopic common bile duct exploration,shorten the surgical recovery time,and reduce the occurrence of bile leakage.