返回式全层连续外翻缝合法在腹腔镜胆总管一期缝合中的应用分析

Clinical application of backtracking full-thickness continuous everting suturing in primary closure of common bile duct after laparoscopic bile duct exploration

目的:分析返回式全层连续外翻缝合法在腹腔镜胆总管一期缝合中的临床应用。方法:回顾分析南京医科大学附属常州第二人民医院2014年2月至2018年11月行腹腔镜胆总管探查并胆总管一期缝合82例患者资料,其中男性45例,女性37例,平均62.7岁。82例胆囊结石合并胆总管结石患者均采用返回式全层连续外翻缝合法行胆总管一期缝合,分析手术和术后相关指标以及预后。结果:所有患者均顺利完成胆总管探查并一期缝合。手术时间45~150 min,平均68.5 min。术中出血量5~150 ml,平均18.4 ml。术后发生胆漏2例(2.4%),无腹腔或胆道出血、胆管炎、肝功能损害、腹腔感染、胆管结石残留等。82例患者中77例(93.9%)获得随访,随访时间9~50个月,中位随访时间14个月。2例(2.4%)胆总管结石复发,1例(1.2%)再发肝内胆管结石,所有患者无胆管狭窄或急性胆管炎等。结论:返回式全层连续外翻缝合法在减少胆总管一期缝合后胆漏并发症方面具有一定的优势,但长期效果还需要进一步的临床验证。

Objective To analyze the results in clinical application of backtracking full-thickness continuous everting suturing in primary closure of common bile duct after laparoscopic bile duct exploration.Methods From February 2014 to November 2018 at the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University,82 patients with cholecystolithiasis and choledocholithiasis entered into this study.There were 45 males and 37 females,with an average age of 62.7 years.These patients underwent primary closure of common bile duct after laparoscopic bile duct exploration using backtracking full-thickness continuous everting suturing to close the incisions in common bile ducts.Clinical data on surgery,postoperative complications and follow-up were collected and analyzed retrospectively.Results Primary closure of common bile duct was successfully carried out in all patients.The operation time ranged from 45 to 150 min(average 68.5 min).Intraoperative blood loss ranged from 5 to 150ml(average 18.4 ml).Postoperative bile leakage occurred in 2 patients(2.4%).There were no intra-abdominal or biliary bleeding,severe cholangitis,liver function derangement,abdominal infection or residual stones.Of 77 patients who were followed up(follow-up rate of 93.9%),the follow-up time ranged from 9 to 50 months(median 14 months).On follow-up,2 patients(2.4%)developed recurrence of choledocholithiasis and 1 patient(1.2%)was diagnosed to have intrahepatic bile duct stones.There were no patients with bile duct stenosis or acute cholangitis.Conclusion Primary closure of common bile duct with backtracking full-thickness continuous everting suturing has the advantage of reducing postoperative bile leakage in patients after laparoscopic bile duct exploration.The long-term effects of this technique still need further clinical studies.