单向倒刺线在腹腔镜肝叶切除联合术中胆道探查中的运用

目的:探讨单向倒刺缝线在腹腔镜下肝叶切除联合术中胆道探查中应用的安全性及有效性。方法:回顾性分析2014年12月—2015年8月期间24例行腹腔镜肝切除联合术中胆道探查术的患者资料,其中10例采用传统缝线缝合胆管(传统缝线组),14例术中采用倒刺线缝合胆管(倒刺线组),比较两组的相关临床资料。结果:所有患者均手术成功,两组患者术前一般资料、术中出血量、术后并发症发生率(肺部感染)、术后住院时间差异均无统计学意义(均P0.05);但倒刺线组手术时间(230.50 min vs.354.68 min)、胆总管缝合时间(5.33 min vs.33.82 min)、肝管缝合时间(9.04 min vs.25.14 min)均明显少于传统缝线组(均P0.05)。所有患者出院1个月返院行T管造影,拔除T管,无结石残留、胆汁漏、胆管狭窄。结论:单向倒刺缝线用于腹腔镜下肝叶切除联合胆道探查术安全、可行,可吸收倒刺缝线的使用可以降低腹腔镜下缝合难度,缩短手术时间和学习曲线,而不增加胆汁渗漏的风险。

Application of unidirectional barbed suture in laparoscopic hepatectomy with bile duct exploration

Objective: To investigate the safety and effectiveness of using unidirectional barbed suture in laparoscopic hepatectomy with intraoperative bile duct exploration. Methods: The clinical data of 24 patients undergoing laparoscopic hepatectomy with synchronous bile duct exploration from December 2014 to August 2015 were retrospectively analyzed. Of the patients, the bile duct closure in 10 cases was accomplished with traditional suture (traditional suture group), and in 14 cases with unidirectional barbed suture (barbed suture group). The main clinical variables between the two groups of patients were compared. Results: The operations in all patients were successfully completed. The preoperative general data, intraoperative blood loss, incidence of postoperative complications (pulmonary infection), and length of postoperative hospital stay had no statistical difference between the two groups (all P>0.05), but the overall operative time (230.50 min vs. 354.68 min), and time for common bile duct (5.33 min vs. 33.82 min) and hepatic duct (9.04 min vs. 25.14 min) suturing were significantly reduced in barbed suture group compared with traditional suture group (all P<0.05). One month after discharge, all patient returned for T-tube cholangiography and T-tube removal, and no retained stones, bile leakage or biliary stricture was observed. Conclusion: Using unidirectional barbed suture in laparoscopic hepatectomy with bile duct exploration is safe and feasible, and the employment of the absorbable barbed suture can reduce the difficulty of laparoscopic suturing, and shorten the operative time and the technical learning curve, without increasing the risk of postoperative bile leakage.