双镜联合胆总管切开取石一期缝合可行性分析

Feasibility of the primary suture for the laparoscopic common bile duct exploration with two monitors

目的探讨双镜联合胆总管切开取石术一期缝合的安全可行性。方法回顾性分析2019年5月至2022年5月176例行双镜联合胆总管切开取石术患者的临床资料,依据取石术后胆总管切口处理方式的不同,分为胆总管一期缝合组(80例)和T管引流组(96例),观察2组患者的相关围手术期数据指标。结果2组患者手术时间、手术出血量、术后住院时间、胆漏发生例数、手术前后炎症指标、手术前后肝功能等,差异无统计学意义(P>0.05);在术后肛门排气时间、术后电解质紊乱发生方面,2组差异有统计学意义(P<0.05)。术后并发症,一期缝合组发生胆漏10例,T管引流组发生6例,均经过通畅术区引流后自行消失,均未发生胆汁性腹膜炎等腹腔感染,拔除引流管前经超声检查无术区及腹腔积液;电解质紊乱在一期缝合组发生4例,T管引流组发生16例,经过调整后恢复正常。结论把握好手术适应症,双镜联合胆总管切开取石,胆总管切口行一期缝合,安全有效,充分体现了双镜联合的优越性,使患者受益。

Objective To explore the safety and feasibility of the primary suture for the laparoscopic common bile duct exploration(LCBDE)with two monitors.Methods Clinical data of 176 patients treated with LCBDE with two monitors from May 2019 to May 2022 were retrospectively analyzed.According to different treatments of common bile duct incision after stone removal,patients were assigned into primary suture group(80 cases)and T-tube drainage group(96 cases).Perioperative data of the two groups were observed.Results There were no significant differences in the operation time,intraoperative blood loss,postoperative length of stay,case number of bile leakage,inflammatory indicators and liver function before and after surgery between the two groups(P>0.05).There were significant differences in postoperative anal exhaust time and postoperative electrolyte imbalance between the primary suture group and the T-tube drainage group(P<0.05).Postoperative complications included 10 cases of bile leakage in the primary suture group and 6 cases in the T-tube drainage group.All of them disappeared after drainage in the unobstructed area.No abdominal infections,such as biliary peritonitis occurred.Before extubating the drainage tube,effusion in the operation area and abdominal cavity was not found by ultrasonography.Electrolyte disorder occurred in 4 cases of the primary suture group and 16 cases of the T-tube drainage group,all of which returned to normal after correction.Conclusion With a strict surgery indications,LCBDE with two monitors and primary suture is safe and effective on removing stones.It offers clinical superiority and benefits patients.