气腹针鞘带线穿刺缝合预防腹腔镜胆囊切除术中戳孔出血的应用体会(附48例报告)

The application of pneumoperitoneal needle sheath combined with thread-loop-puncturing suture technique in preventing of puncture hemorrhage during laparoscopic cholecystectomy:with a report of 48 cases

目的:探讨气腹针穿刺联合线袢带线缝合技术在腹腔镜胆囊切除术中预防戳孔出血的应用优势。方法:观察并分析2016年1月至2021年6月为48例腹腔镜胆囊切除术患者采用气腹针穿刺联合线袢带线缝合技术的术中操作流程与术后疗效。结果:48例均顺利完成手术,手术时间30~80 min,平均(51±3.8)min。术后患者均恢复顺利,无术后出血、胆漏、术区积液、感染等并发症发生;患者均于术后2~5 d、平均(3.5±1.2)d出院。术后随访6~9个月,无切口裂开、戳孔疝、皮下血肿、感染等远期并发症发生,切口愈合良好,达到深部缝合目的。结论:气腹针鞘联合线袢带线穿刺缝合技术通过穿刺不同层面组织,并利用线袢带线,可取得深部缝合、分层缝合、全层缝合等优势,对于预防腹腔镜胆囊切除术中戳孔出血或困难戳孔缝合具有操作简单、流程稳定、安全可靠、疗效良好的特点,值得临床推广。

Objective:To investigate the advantages of pneumoperitoneal needle puncture combined with line loop suture technique in laparoscopic cholecystectomy in prevention of puncture hemorrhage.Methods:The intraoperative procedure and postoperative efficacy of 48 patients who underwent laparoscopic cholecystectomy were observed and analyzed,they received pneumoperitoneal needle puncture combined with line loop suture technique from Jan.2016 to Jun.2021.Results:All 48 cases were successfully operated,the operation time was 30-80 min,with the mean of(51±3.8)min.Postoperative recovery was smooth without complications such as postoperative bleeding,biliary leakage,effusion at operative area or infection.All patients were discharged from hospital 2-5 d postoperatively,the mean was(3.5±1.2)d.At the postoperative follow-up of 6-9 months,no long-term complications such as wound dehiscence,puncture hernia,subcutaneous hematoma and infection occurred.The incision healed well and achieved deep suturing.Conclusions:The pneumoperitoneal needle combined with thread loop puncture suturing technique can obtain the advantages of deep suture,layered suture and full layer suture by puncturing the tissue of different layers and using the thread loop to guide another thread or thread loop to suture.It has the characteristics of simple,safe and reliable operation,stable process,and good efficacy for preventing intraoperative puncture hemorrhage or difficult puncture suture in laparoscopic cholecystectomy,and is worthy of clinical promotion.