可吸收单向倒刺缝线在老年腹腔镜胆总管一期缝合术51例中的应用

Application of absorbable unidirectional barbed suture in 51 cases of laparoscopic primary suture of the common bile duct in elderly patients

目的 探讨可吸收单向倒刺缝线在老年腹腔镜胆总管一期缝合术中的临床应用效果。方法 选取淮南市第一人民医院2017年6月至2020年5月收治的年龄≥60岁的102例胆总管一期缝合术的病人资料,分为研究组和对照组各51例。研究组均采用可吸收单向倒刺线一期缝合胆总管的老年病人资料,对照组采用普通可吸收线一期缝合胆总管的老年病人资料,比较两组术中缝合时间、术中出血量、术后首次下床时间、术后首次排气时间、术后住院时间及术后胆漏的发生率。结果 两组比较,年龄、性别、胆总管直径、最大结石直径、总胆红素、合并症等一般资料均差异无统计学意义(P>0.05)。采用独立样本t检验及χ^(2)检验比较,研究组术后缝合时间[(9.06±2.81)min比(16.16±3.09)min]、术中出血量[(38.47±8.43)mL比(46.16±6.52)mL]、术后住院时间[(4.88±1.01)d比(6.51±1.39)d]均少于对照组,差异有统计学意义(P<0.05);研究组术后首次下床时间[(2.45±0.73)d比(2.75±0.65)d]、术后首次排气时间[(2.27±0.77)d比(2.65±0.77)d]、病人就医满意度[(4.37±0.77)分比(3.10±0.72)分]均优于对照组,差异有统计学意义(P<0.05)。研究组术后胆漏发生率(1.9%)明显低于对照组(9.8%)。结论 腹腔镜下可吸收单向倒刺线一期缝合胆总管能明显缩短老年病人术中缝合时间、减少术中出血,降低胆漏等常见并发症,促进术后恢复,是安全可行的。

Objective To explore the clinical effect of absorbable unidirectional barbed sutures in elderly laparoscopic primary sutures of the common bile duct.Methods The data of 102 patients with primary suture of common bile duct were admitted to Huainan First People’s Hospital from June 2017 to May 2020,age ≥ 60 years were selected and divided into a study group and a control group with 51 cases in each.The patients in the study group were sutured to the common bile duct with absorbable unidirectional barbed sutures in one stage,and the patients in the control group were sutured with ordinary absorbable sutures in one stage.The intraoperative suture time,intraoperative blood loss,postoperative first ambulation time,postoperative first exhaust time,postoperative hospital stay and incidence of postoperative bile leakage were compared between the two groups.Results There were no significant differences in age,sex,common bile duct diameter,maximum stone diameter,total bilirubin,or comorbidities between the two groups(P > 0.05).The independent samples t test and χ~2test showed that the postoperative suture time [(9.06±2.81) min vs.(16.16±3.09) min],intraoperative blood loss [(38.47±8.43) mL vs.(46.16±6.52) mL],and postoperative hospital stay [(4.88±1.01) d vs.(6.51±1.39) d] were less than those in the control group,and the difference was statistically significant(P < 0.05).The time of first getting out of bed after operation in the study group [(2.45±0.73) d vs.(2.75±0.65) d],the first postoperative exhaust time [(2.27±0.77) d vs.(2.65±0.77) d],and patient satisfaction with medical treatment [(4.37±0.77) points vs.(3.10±0.72) points] were better than those in the control group,and the difference was statistically significant(P<0.05).The incidence of postoperative bile leakage in the study group(1.9%) was significantly lower than that in the control group(9.8%).Conclusions Primary suture of the common bile duct with absorbable unidirectional barbed sutures under laparoscopy can significantly shorten the suture time,reduce intraoperative bleeding,reduce common complications such as bile leakage,and promote postoperative recovery in elderly patients,which is safe and feasible.