单向可吸收倒刺线与PDS-Ⅱ缝线在腹腔镜胰十二脂肠切除术胆肠吻合中的应用及对比分析

Application and comparative analysis of unidirectional absorbable barbed suture and PDS-Ⅱsuture in laparoscopic pancreaticoduodenectomy with cholangiojejunostomy

目的探讨单向可吸收倒刺线与PDS-Ⅱ缝线在腹腔镜胰十二脂肠切除术胆肠吻合中的应用价值。方法采用回顾性队列研究方法,收集2017年1月至2020年6月内江市第二人民医院收治的60例行腹腔镜胰十二脂肠切除术患者的临床资料,其中30例患者胆肠吻合时采用单向可吸收倒刺线,设为倒刺线组;另30例患者胆肠吻合时采用PDS-Ⅱ缝线,设为PDS-Ⅱ组。观察两组手术时间、术中出血量、肝总管直径、胆肠吻合口内径和术后并发症情况。结果(1)术中情况:两组患者均完成腹腔镜根治性胰十二指肠切除术,胆肠吻合均采用横结肠后Roux-en-Y吻合方式,均未放置T管引流,无姑息性胆肠吻合减黄。与PDS-Ⅱ组比较,倒刺线组胆肠吻合手术时间缩短[(13.2±8.1)min vs(15.8±7.6)min],差异有统计学意义(P<0.05),但术中出血量[(80±8)mL vs(94±5)mL]、肝总管直径[(1.5±0.6)cm vs(1.3±0.8)cm]、胆肠吻合口内径[(1.3±0.8)cm vs(1.1±0.6)cm],两组差异均无统计学意义(P>0.05)。(2)术后情况:与PDS-Ⅱ组比较,倒刺线组患者术后胆漏[0例(0)vs 3例(10%)]、术后胆肠吻合口后方引流管拔出时间[(3.8±0.9)d vs(7.2±0.3)d]、术后住院时间[(7.8±0.9)d vs(10.2±0.6)d]均降低,差异有统计学意义(P<0.05)。(3)随访情况:60例患者均获得随访,随访时间6-12个月,中位随访时间8个月,与PDS-Ⅱ组比较,倒刺线组患者术后胆肠吻合口狭窄[2例(6.7%)vs 5例(16.7%)]和狭窄胆肠吻合口拆除再吻合发生率下降[0例(0)vs 3例(10%)],差异有统计学意义(P<0.05)。术后反流性胆道感染发生率[2例(6.7%)vs 3例(10.0%)],差异无统计学意义(P>0.05)。结论单向可吸收倒刺线在腹腔镜胰十二脂肠切除术胆肠吻合中的应用是安全、有效的,能够减少胆肠吻合口狭窄及胆漏的发生率。

Objective To explore the application value of unidirectional absorbable barbed suture and PDS-Ⅱ suture in laparoscopic pancreaticoduodenectomy(LPD)with cholangiojejunostomy.Methods A retrospective cohort study was performed in 60 patients who underwent LPD in Neijiang Second People’s Hospital between Jan.2017 and Jun.2020.Among them,30 patients were treated with unidirectional absorbable barbed suture during the biliary-enteric anastomosis(barbed suture group),and the other 30 patients were treated with PDS-Ⅱ suture during the biliary-enteric anastomosis(PDS-Ⅱ group).The operation time,intraoperative blood loss,the diameter of common hepatic duct,the inner diameter of biliary-enteric anastomosis and postoperative complications were recorded and compared between the two groups.Results Patients in both groups completed radical LPD during which the biliary-enteric anastomosis was performed by the transverse colon and Roux-en-Y anastomosis.T-tube drainage was not placed in situ and there was no palliative treatment was given.Compared with the PDS-Ⅱ group,the operation time for the cholangiojejunostomy in barbed suture group were significantly shortened[(13.2±8.1)min vs(15.8±7.6)min,P<0.05].The amount of intraoperative blood loss[(80±8)mL vs(94±5)mL],the diameter of the common hepatic duct[(1.5±0.6)cm vs(1.3±0.8)cm]and the inner diameter of the biliary-enteric anastomosis[(1.3±0.8)cm vs(1.1±0.6)cm]were not significantly different between the two groups(P>0.05).Compared with the PDS-Ⅱ group,the incidence of postoperative bile leakage in the barbed suture group[0 case(0)vs 3 cases(10%)],the drainage tube removal time after postoperative biliary-enteric anastomosis[(3.8±0.9)d vs(7.2±0.3)d],postoperative hospitalization time[(7.8±0.9)d vs(10.2±0.6)d]were all lower in the barbed group(P<0.05).All 60 patients were followed-up for 6-12 months with a median followup time of 8 months.Compared with the PDS-Ⅱ group,patients in barbed suture group had significantly less postoperative biliary anastomosis stenosis[2 cases(6.7%)vs 5 cases(16.7%)]and a lower incidence of stenosis biliary-enteric anastomosis after removal and anastomosis decreased[0 case(0)vs 3 cases(10%),P<0.05].No statistical differences were observed between the two groups in terms of incidence of postoperative reflux biliary tract infection[2 cases(6.7%)vs 3 cases(10%),P>0.05].Conclusion Application of unidirectional absorbable barbed suture in LPD for biliary-enteric anastomosis is safe and effective.This approach can be used to reduce the incidence of biliary-enteric anastomosis stenosis and postoperative bile leakage.