3D腹腔镜胆总管切开一期缝合60例临床分析

Clinical analysis of 60 cases of three-dimensional laparoscopic choledochotomy with primary suture

目的探讨3D腹腔镜在胆总管切开一期缝合术中的临床应用效果。方法回顾性分析江门市中心医院肝胆外科2016年6月至2018年12月期间收治的60例胆总管结石患者的临床资料。按照治疗方法不同把患者均分为常规组、观察组,每组30例。常规组患者采用2D腹腔镜胆总管切开取石,观察组患者采用3D腹腔镜胆总管切开取石。比较两组患者的临床疗效、住院时间、手术时间、术中出血量及并发症发生情况。结果观察组患者的治疗总有效率为93.33%,明显高于常规组的73.33%,差异有统计学意义(P<0.05);两组患者的手术时间、术中出血量比较,差异均无统计学意义(P>0.05);观察组患者的肛门排气恢复时间、住院时间分别为(26.47±6.70) h、(5.19±1.60) d,明显短于常规组的(39.78±8.30) h、(8.29±2.40) d,差异均有统计学意义(P<0.05);观察组患者的并发症发生率为13.33%,明显低于常规组的43.33%,差异有统计学意义(P<0.05)。结论 3D腹腔镜下切开胆道取石后行胆总管一期缝合可有效降低患者术中出血量,缩短住院时间,提高生存质量,减少并发症发生。

Objective To explore the clinical effect of three-dimensional laparoscopy in primary suture after laparoscopic choledochotomy of common bile duct. Methods The clinical data of 60 patients with choledocholithiasis admitted to the Department of Hepatobiliary Surgery, Jiangmen Central Hospital from June 2016 to December 2018 were retrospectively analyzed. The patients were divided into routine group and observation group according to different treatment methods, with 30 cases in each group. The routine group was treated with 2D laparoscopic choledocholithotomy, while the observation group was treated with 3D laparoscopic choledocholithotomy. The clinical effects, length of hospital stay, operation time, intraoperative bleeding volume, and complications of the two groups were compared. Results The total effective rate of the observation group (93.33%) was significantly higher than that of the routine group (73.33%), and the difference was statistically significant (P<0.05). There was no significant difference in operation time, intraoperative bleeding volume between the two groups (P>0.05). The recovery time of anal exhaust and length of hospital stay in the observation group were (26.47±6.70) h and (5.19±1.60) d, respectively, which were significantly shorter than (39.78±8.30) h and (8.29±2.40) d in the routine group (P<0.05). The incidence of complications in the observation group was 13.33%, significantly lower than 43.33% in the routine group (P<0.05). Conclusion The primary suture of common bile duct after 3D laparoscopic choledocholithotomy can effectively reduce the blood loss during operation, shorten the length of hospital stay, improve the quality of life, and reduce complications.