胆囊壁一针两层连续缝合法在微创保胆手术中的应用

Application of continuous two-layer suture of gallbladder incision with a single absorbable suture on laparoscopic gallbladder-preserving cholecystolithotomy

摘要:

探讨黏膜层连续外翻、浆肌层连续内翻缝合的一针两层连续缝合法在微创保胆手术中的应用。方法 回顾性分析该院74例接受微创保胆取石手术患者的临床资料，重点介绍胆囊壁切口的缝合方法。主要手术步骤包括胆囊体部纵行切开，胆道镜探查并取尽结石；4-0可吸收线自切口上端开始连续外翻缝合黏膜层，缝合至切口下端，自浆膜层出针后连续内翻缝合浆肌层；缝合边距和针距皆为1 mm左右。术后口服熊去氧胆酸半年。结果 所有病例皆采用一针两层连续缝合法顺利完成完全腹腔镜下保胆取石手术。手术时间33～78 min，平均（45.11±14.96）min；胆囊壁缝合时间9～22 min，平均（14.86±3.88）min。无胆漏、腹膜炎、结石残留、胆囊或腹腔内出血、切口或腹腔感染等并发症。术后住院时间2～4 d，平均（3.21±0.69）d。术后随访3～62个月，平均（35.50±18.94）个月，复发2例，复发率2.7%。结论 黏膜层连续外翻、浆肌层连续内翻缝合的一针两层连续缝合法安全、可靠，是微创保胆手术中较理想的关闭胆囊壁切口的方法。

Abstract:

To evaluate the clinical application of continuous two-layer suture of gallbladder incision with a single absorbable suture on laparoscopic minimally invasive gallbladder-preserving cholecystolithotomy. Methods The clinical data of 74 cases underwent laparoscopic minimally invasive gallbladder-preserving cholecystolithotomy were retrospectively analyzed. Main surgical procedures included the longitudinal incision of gallbladder wall, choledochoscopy and the removal of all stones and the closure of the gallbladder incision. The mucous incision was first closed using a 4-0 absorbable suture with continuous everting suture. Using the same suture, the seromuscular incision was then closed with continuous invering suture. The operation time, suturing time, complications and postoperative hospitalization time were also documented. Results Laparoscopic gallbladder-preserving cholecystolithotomy was successfully performed in all cases using the suturing technique introduced in Methods. The operation time was 33~78 min (average 45.11 ± 14.96 min). Suturing time for gallbladder incision was 9 ~ 22 min (average 14.86 ± 3.88 min). No severe complications occurred, such as bile leakage, peritonitis, residual gallstone, hemorrhage or infection. The postoperative hospitalization time was 2~4 d (average 3.21 ± 0.69 d). A postoperative follow-up of 3 ~ 62 months (average 35.50 ± 18.94 months) indicated gallbladder stone recurrence of 2 cases, with a recurrence rate of 2.7%. Continuous two-layer suture of gallbladder incision with a single absorbable suture is a safe, practical and reliable technique for the closure of the gallbladder incision in laparoscopic gallbladder-preserving cholecystolithotomy.