单向倒刺线在腹腔镜胆总管探查一期连续缝合中的应用

【摘 要】 目的 探讨单向倒刺线连续缝合在腹腔镜胆总管探查一期缝合术中闭合胆总管的安全性和有效性。方法 对2016年6月至2017年12月西安交通大学第一附属医院进行腹腔镜胆总管探查一期缝合术治疗的81例胆总管结石患者进行前瞻性研究。按照随机数字表法，患者分为单向倒刺线连续缝合组（41例）和普通可吸收线连续缝合组（40例）。比较两组患者胆总管闭合缝合时间，术后并发症情况，术后住院时间及随访情况。结果 两组患者均手术成功，术中结石取净，无术中并发症。倒刺线组胆总管缝合时间明显少于普通线组（11.4±2.0）min vs （15.6±3.5）min，t=-6.67，P < 0.05]；两组胆漏发生率（2.4% vs 5.0%），急性胆管炎发生率（4.9% vs 5.0%），术后平均住院时间（4.4±1.2）d vs（4.4±1.6）d]差异均无统计学意义（P > 0.05）。所有患者均获得随访，随访半年以上者倒刺线组18例，普通线组15例，尚未见结石残余、结石复发或胆管狭窄情况。结论 单向倒刺缝线连续缝合用于腹腔镜胆总管探查一期缝合术安全可行，可以降低腹腔镜下缝合难度，缩短缝合时间，并且不增加并发症风险.

Application of unidirectional barbed suture in primary continuous closure of laparoscopic common bile duct exploration

Abstract objective To investigate the safety and efficacy of unidirectional barbed suture in primary continuous closure of laparoscopic common bile duct exploration. Methods A total of 81 patients with choledocholithiasis underwent laparoscopic common bile duct exploration from Jun. 2016 to Dec. 2017 were prospectively analyzed. According to the random number table method, patients were randomly divided into unidirectional barbed suture group (n=41) and normal absorbable suture group (n=40). The time of common bile duct suture closure, postoperative complications, postoperative hospitalization duration and follow-up were recorded and compared. Results All the patients were successfully operated, and the stones were removed during operation. There was no intraoperative complications. Time of common bile duct suture closure in unidirectional barbed suture group was less than that in normal absorbable suture group (11.4±2.0) min vs (15.6±3.5) min, t=-6.67, P<0.05]. The incidence of bile leakage (2.4% vs 5.0%), acute cholangitis (4.9% vs 5.0%), and the average postoperative hospitalization duration (4.4±1.2) d vs (4.4±1.6) d] between the two groups were not statistically significant (P>0.05). All patients were followed up. Eighteen cases in unidirectional barbed suture group and 15 cases in normal absorbable suture group were followed up for more than half a year. No residual stones, recurrence of stones or bile duct stricture was found after operation. Conclusion Laparoscopic common bile duct exploration with continuous unidirectional barbed closure is safe and feasible, which can reduce laparoscopic suture difficulty, shorten the suture time, and does not increase the incidence risk of complications.