腹腔镜下应用倒刺线行胆肠吻合的临床分析
Clinical analysis of laparoscopic choledochojejunostomy with barbed suture
罗琦弋 1谭喜娟 1陆礼柏 1罗宗将 1马嘉盛 1赵振荣 1汪建初1
作者信息
- 1. 右江民族医学院附属医院百东院区肝胆胰外科&肥胖与代谢病外科,广西 百色,533000
- 折叠
摘要
目的:探讨腹腔镜下应用倒刺线行胆肠吻合的可行性、安全性.方法:回顾分析2021 年1 月至2023 年7 月行腹腔镜胆肠吻合的38 例患者的临床资料,根据使用的缝线分为倒刺线组(n=18)与对照组(n=20),倒刺线组于腹腔镜下应用倒刺线行胆肠吻合,其中良性病变12 例,包括Ⅰ型、Ⅳb 型胆总管囊肿9 例,胆总管下端狭窄2 例,吻合口狭窄拆除重建1 例;恶性病变6 例,包括胰头癌3 例、壶腹周围癌3 例.对照组于腹腔镜下使用可吸收缝线行胆肠吻合,其中良性病变13 例,均为Ⅰ型、Ⅳb 型胆总管囊肿;恶性病变7 例,包括胰头癌3 例、壶腹周围癌4 例.对比分析两组围手术期临床指标.结果:倒刺线组胆肠缝合时间短于对照组,差异有统计学意义[(16.90±1.33)min vs.(23.06±2.44)min,P＜0.05],倒刺线组与对照组肝总管内径[(18.83±2.92)mm vs.(19.80±1.91)mm]、胆肠吻合口内径[(17.33±2.47)mm vs.(18.00±1.75)mm]差异无统计学意义(P＞0.05).两组术后胆肠吻合口引流管拔除时间、吻合口漏及第1 天、第3 天、第7 天肝功能、感染指标差异无统计学意义(P＞0.05),两组均未发生狭窄.患者均顺利恢复出院.术后 1～3 个月门诊复查CT,未发现胆管扩张、新增腹腔积液,无腹痛、发热等症状,近期预后良好.结论:腹腔镜下应用倒刺线行胆肠吻合是安全、可行的,可缩短胆肠吻合口的缝合时间.
Abstract
Objective:To investigate the feasibility and safety of laparoscopic application of barbed wire for biliary-enteric anas-tomosis.Methods:Retrospective analysis was made on clinical data of 38 patients who underwent laparoscopic biliary-intestinal anasto-mosis from Jan.2021 to Jul.2023.Patients were divided into the barbed wire group(n=18)and the control group(n=20)based on the type of suture material used.In the barbed wire group,barbed wire was used in laparoscopic biliary-intestinal anastomosis,including 18 cases of benign lesions(9 cases of typeⅠor typeⅣb choledochal cysts,2 cases of distal common bile duct stricture,and 1 case of anastomotic stricture reconstruction)and 6 cases of malignant lesions(3 cases of pancreatic head cancer and 3 cases of periampullary cancer).In the control group,the laparoscopic biliary-intestinal anastomosis was performed with absorbable surgical sutures,including 13 cases with benign lesions(all typeⅠor typeⅣb choledochal cysts)and 7 cases with malignant lesions(3 cases of pancreatic head cancer and 4 cases of periampullary cancer).Perioperative clinical indexes of the two groups were comparatively analyzed.Results:The biliary-intestinal anastomosis time was shorter in the barbed wire group than that in the control group,with statistically significant diffe-rence[(16.90±1.33)min vs.(23.06±2.44)min,P＜0.05].There was no statistically significant difference in the intrahepatic bile duct diameter[(18.83±2.92)mm vs.(19.80±1.91)mm]and anastomotic stoma inner diameter[(17.33±2.47)mm vs.(18.00±1.75)mm]between the two groups(P＞0.05).There were no statistically significant differences between the two groups in the post-operative removal time of drainage tubes at biliary-intestinal anastomotic stoma,anastomotic leakage,liver function and infection indica-tors on postoperative 1st,3rd,and 7th day(P＞0.05).Both groups did not experience any strictures.All patients recovered smoothly and were safely discharged.Follow-up CT scans at 1-3 months after operation showed no bile duct dilatation,new hydrops abdominis,the short-term prognosis was satisfying without abdominal pain,fever or other symptoms.Conclusions:The application of barbed wire in laparoscopic biliary-intestinal anastomosis is safe and feasible,and can shorten the suture time of biliary-enteric anastomosis.
关键词
腹腔镜检查/胆肠吻合/倒刺线Key words
Laparoscopy/Biliary-enteric anastomosis/Barbed wire引用本文复制引用
基金项目
国家自然科学基金(82060441)
广西临床重点专科建设项目(桂卫医发202217号)
广西高等教育本科教育改革工程项目重点项目(2021JGZ147)
出版年
2024
国家科技期刊平台
NSTL
万方数据