J管内引流一期缝合在腹腔镜胆总管探查术中的应用

Study on application of J-tube internal drainage and primary suture in laparoscopic common bile duct exploration

目的探讨腹腔镜胆总管探查术后J管引流一期缝合的可行性、适应证及并发症的相关影响因素。方法通过在实验室模拟胆汁环境进行体外试验,探讨2种可吸收缝合线(4-0 Vicryl、6-0 Vicryl)张力维持时间。选取本地健康杂种犬20只进行动物实验(分为4-0 Vicryl、6-0 Vicryl组,分别预置J管并缝合固定),进一步研究J管在胆总管中可提供的有效支撑时间。最终通过选取2011年3月至2015年3月在该院住院治疗的134例胆总管结石患者进行临床研究(置J管引流并缝合固定),验证其可行性并探讨其适应证及并发症的相关因素。结果 4-0 Vicryl与6-0 Vicryl在体外完全分解分别需56、49 d;在动物体内4-0 Vicryl固定J管有效支撑时间为(21.7±3.3)d,6-0 Vicryl固定J管有效支撑时间为﹙17.2±2.9)d,二者比较,差异无统计学意义(P=0.787);临床研究中134例胆总管结石患者均治愈出院。结论腹腔镜胆总管探查术后行J管引流一期缝合安全、可行,具有一定的应用价值。

Objective To study the feasibility,indications and complications related factors of J-tube drainage and primary suture after laparoscopic common bile duct exploration. Methods The in vitro experiment was performed by the experimental simulation bile environment to study the tension maintenance time of two kinds of absorbable suture（4-0 Vicryl,6-0 Vicryl）.The animal experiment by selecting 20 native healthy crossbreed dogs（including the 4-0 Vicryl and 6-0 Vicryl groups,respectively presetting J-tube and conducting the suture fixation） was performed to further study the effective supporting time provided by Jtube in the common bile duct;finally the clinical study（J-tube drainage plus suture fixation） was performed in the patients with common bile duct calculi hospitalized in our hospital from March 2011 to March 2015 for verifying its feasibility and investigating its indications and complications related factors. Results The in vitro complete decomposition of Vicryl 4-0 and Vicryl 6-0 needed 56 d and 49 d respectively;the effective supporting time of Vicryl 4-0 for fixing J-tube in animal in vivo was（21.7±3.3）d,which of 6-0 Vicryl was（17.2±2.9）d,the difference between them had no statistical significance（P=0.787）;in the clinical study,134 cases of common bile duct calculi were cured and discharged from hospital. Conclusion Conducting the J-tube drainage and primary suture after laparoscopic common bile duct exploration is safe and feasible,and has a certain application value.