两种胆总管缝合技术在腹腔镜胆总管探查术开展早期的应用比较

Comparison between two suture methods of common bile duct in early stage of laparoscopic common bile duct exploration

目的:比较直针法与弯针法缝合技术在腹腔镜胆总管探查术开展早期的可行性及临床应用价值。方法:选取78例胆囊结石合并胆总管结石患者,随机分为直针法组与弯针法组,每组39例,两组患者年龄、性别、胆管炎或胰腺炎病史、总胆红素、直接胆红素、碱性磷酸酶、γ-谷氨酰转肽酶、胆总管直径等差异均无统计学意义(P>0.05),依照缝合方法分别行腹腔镜胆总管探查取石T管引流后的胆总管缝合,对比分析两组患者术中出血量、胆总管取石数量、术后胆漏及住院时间等指标。结果:78例手术均获成功,无一例中转开腹,直针法手术时间平均(107.0±23.5)min,弯针法平均(126.0±27.2)min;直针法手术时间明显缩短,差异有统计学意义(P<0.05)。术中出血量、胆总管取石数量、术后胆漏及住院时间两组差异无统计学意义(P>0.05)。结论:相较弯针缝合法,直针缝合法行腹腔镜胆总管探查取石T管引流后的胆总管缝合切实可行,对早期开展此类手术的医师而言,优势明显,值得临床应用。

Objective： To compare the feasibility and clinical value of straight needle suture and curve needle suture in early stage of laparoscopic common bile duct exploration. Methods： Seventy-eight patients with cholecystolithiasis and choledocholithiasis were randomly divided into straight needle method group（ n = 39） and curve needle method group（ n = 39）. Patients in each group had no obvious differences in age,gender,course of cholangitis and pancreatitis,TBIL,DBIL,AKP,γ-GT,diameter of common bile duct（ P〈0. 05）,two groups were treated with laparoscopic common bile duct exploration and T-tube drainage,common bile duct suture was performed according to suture methods of each group. The blood loss during operation,the amount of common bile stone removed,postoperative bile leakage,hospital stay were compared between the two groups. Results： The operations of 78 patients in two groups were successfully performed,no one was converted to open operation. The average operation time of straight needle method group was（ 107 ±23. 5） min while that of curve needle method group was（ 126 ± 27. 2） min,the operation time of straight needle method group was obviously shorter than that of curve needle method group. There was significant difference in average operation time（ P〈0. 05） and no significant difference in blood loss during operation,the amount of common bile stone removed,postoperative bile leakage and hospital stay（ P〈0. 05） between two groups. Conclusions： Compared with curve needle suture method,the operation of common bile duct suture with straight needle method after exploration and T-tube drainage is feasible and worthy of clinical application,which has more advantages than curved needle method in early stage.