倒钩线连续全层缝合在腹腔镜下胆总管一期缝合中的应用

Application of continuous full-thickness suture with barbed thread for laparoscopic common bile duct primary closure

目的探讨V-Loc?180倒钩线(倒钩线)连续全层缝合在腹腔镜下胆总管一期缝合中的应用价值。方法回顾性分析2014年1月至2015年12月在中山大学附属江门市中心医院行腹腔镜胆总管切开取石术的45例胆总管结石患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。根据术中胆总管缝合方法不同分成倒钩线组和对照组。其中倒钩线组23例,男14例,女9例;平均年龄(56±14)岁;采用倒钩线连续全层缝合胆总管。对照组22例,男11例,女11例;平均年龄(55±14)岁;采用3-0 Polysorb^(TM)线间断全层缝合胆总管。术后定期随访,观察两组患者的术中和术后情况。两组胆总管缝合时间的比较采用t检验;两组胆漏发生率的比较采用连续性校正χ~2检验,结石残留率的比较采用Fisher确切概率法。结果所有患者均手术成功,无中转开腹,无围手术期死亡。倒钩线组患者胆总管缝合时间为(14±3)min,明显短于对照组的(48±4)min(t=-35.472,P<0.05)。倒钩线组患者术后发生胆漏2例,对照组2例,两组胆漏发生率比较差异无统计学意义(χ~2<0.001,P=1.000)。倒钩线组术后发生结石残留1例,对照组1例,两组结石残留率比较差异无统计学意义(P=1.000)。随访期间所有患者未见结石复发或胆管狭窄。结论腹腔镜下胆总管一期缝合中采用倒钩线连续全层缝合安全、有效,可明显减少缝合时间,且不增加术后并发症发生率。

Objective To evaluate the application value of continuous full-thickness suture with V-LocTM 180 barbed thread （barbed thread） for laparoscopic common bile duct primary closure. Methods Clinical data of 45 patients with choledocholithiasis who underwent laparoscopic choledocholithotomy in Central Hospital of Jiangmen affiliated to Sun Yat-sen University between January 2014 and December 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the intraoperative suture method of common bile duct, all patients were divided into the barbed suture group （n=23） and control group （n=22）. In the barbed suture group, 14 were males and 9 were females with the average age of （5±14） years old, and the common bile duct was continuous full-thickness sutured with barbed thread. In the control group, 11 were males and11 were females with the average age of （55±14） years old, and the common bile duct was intermittent full-thickness sutured with 3-0 PolysorbTM thread. Intraoperative and postoperative conditions of the patientsin two groups were observed during postoperative follow-up. The suture time of common bile duct in two groups was compared using t test, the incidence of bile leakage was compared using Chi-square test with Yates continuity correction, and the residual stone rate was compared using Fisher＇s exact probability method. Results All patients underwent the surgery successfully. No conversion to open surgery or perioperative death was observed. The suture time of common bile duct in the barbed suture group was （14±3） min, significantly shorter than （48±4） min in the control group （t=-35.472, P〈0.05）. Two cases of bile leakage was respectively observed in the barbed suture group and control group, and no significant difference was observed in the incidence of bile leakage between two groups （χ2〈0.001, P=0.000）. One case of residual stone after surgery was respectively observed in the barbed suture group and control group, and no significant difference was observed in the residual stone rate between two groups （P=1.000）. No residual stone recurrence or biliary stricture was observed during the follow-up. Conclusions Continuous full-thickness suture with barbed thread is a safe and efficacious technique for laparoscopic common bile duct primary closure. It can significantly shorten the suture time without increasing the incidence of postoperative complications.