两种胆总管缝合技术在腹腔镜胆总管结石手术中的应用比较

Application comparison between two suture methods of common bile duct in laparoscopic choledocholithiasis

目的探讨“三针法”与传统方法缝合胆总管技术在腹腔镜下胆总管切开取石、T管引流术治疗胆总管结石患者中的临床应用价值。方法回顾性分析2014年1月至2017年10月该院收治的81例胆总管结石微创手术患者的临床资料,患者胆总管直径为0.6~1.0 cm,均在腹腔镜下行胆总管切开取石、T管引流术,其中传统方法缝合胆总管23例(对照组),“三针法”缝合胆总管58例(观察组)。观察两种方法胆总管缝合时间、术后胆漏的发生率、术后住院时间及治疗总费用情况。结果81例患者均成功在腹腔镜下完成胆总管切开取石及T管引流术,无中转开腹。对照组患者缝合胆总管时间为(15.74±2.49)min,观察组患者缝合胆总管时间为(8.00±1.17)min,两组比较差异有统计学意义(P<0.05)。两组患者术后胆漏发生率、术后住院时间、治疗总费用比较,差异无统计学意义(P>0.05)。结论“三针法”缝合胆总管较传统方法难度低,可缩短缝合时间。

Objective To compare the clinical application values between three stitches and traditional method for suturing common bile duct in laparoscopic choledocholithiasis and T-tube drainage for treating choledocholithiasis.Methods The clinical data in 81 patients with choledocholithiasis treated by common bile duct microinvasive operation in this hospital from Jan.2014 to Oct.2017,the common bile duct diameter 0.6-1.0 cm,were retrospectively analyzed.The cases underwent laparoscopic choledocholithiasis and T-tube drainage,in which 23 cases adopted the traditional method for suturing the common bile duct(control group)and 58 cases adopted the three stitches for suturing the common bile duct(observation group).The suture time of common bile duct,occurrence rate of postoperative bile leakage,postoperative hospitalization duration and total costs were observed in the two groups.Results Eighty-one cases successfully performed the laparoscopic choledocholithiasis operation and T-tube drainage without conversing to laparotomy.The common bile duct closure time was(15.74±2.49)min in the control group and(8.00±1.17)min in the observation group,and the difference was statistically significant(P<0.05).There were no statistically significant differences in the occurrence rate of bile leakage,postoperative hospitalization duration and total cost between the two groups(P>0.05).Conclusion The three stitches method for suturing the common bile duct has low difficulty than the traditional suture method,thus shortens the suture time.