腹腔镜下胆总管切开探查术一期缝合中应用连续缝合的可行性与安全性分析

Feasibility and safety analysis of continuous suture in primary suture of laparoscopic common bile duct exploration

摘要:

目的 探讨连续缝合应用于腹腔镜下胆总管切开探查术一期缝合中的可行性与安全性。方法 选取2018年10月－2022年9月该院诊治的胆总管结石患者70例，两组患者均行腹腔镜下胆总管切开探查术，根据不同缝合方式，分为：间断缝合组（35例）和连续缝合组（35例）。两组患者均行相同的术后处理，并持续6个月的随访。对比两组患者手术相关指标、术后恢复指标、术前及术后14 d生活质量、术前及术后3 d炎症指标及应激反应指标、随访期间并发症发生情况、结石残留情况和复发情况等。结果 连续缝合组胆总管缝合时间、手术时间、住院时间和引流管拔除时间短于间断缝合组，术中出血量少于间断缝合租，视觉模拟评分法（VAS）低于间断缝合组，差异均有统计学意义（P < 0.05）；两组患者术后14 d胃肠道生活质量指数（GIQLI）各项得分和总分较术前升高，连续缝合组高于间断缝合组，差异均有统计学意义（P < 0.05）；两组患者术后3 d血清白细胞介素-6（IL-6）、降钙素原（PCT）、促肾上腺皮质激素（ACTH）、皮质醇（Cor）、去甲肾上腺素（NE）、C-肽（C-P）水平和外周血中性粒细胞（NEUT）较术前升高，连续缝合组低于间断缝合组，差异均有统计学意义（P < 0.05）；两组患者并发症总发生率、结石残留率和结石复发率比较，差异均无统计学意义（P > 0.05）。结论 腹腔镜下胆总管切开探查术一期缝合中应用连续缝合，可改进手术相关指标，缓解术后炎症和应激反应，提高患者生活质量，且不增加结石残留和结石复发风险。

Abstract:

Objective To investigate the feasibility and safety of continuous suture in laparoscopic common bile duct exploration of primary suture.Methods 70 patients with calculus of common bile duct treated from October 2018 to September 2022 were selected. Both groups underwent laparoscopic common bile duct exploration and were divided into the intermittent suture group (35 cases) and the continuous suture group (35 cases) according to different suture methods. Both groups received the same postoperative treatment, they were followed up for 6 months. The operation-related indexes, postoperative recovery indexes, quality of life before and 14 days after operation, inflammatory reaction and stress response before and 3 days after operation, complications and residual and recurrence of stones during follow-up were compared between the two groups.Results The suture time of common bile duct, operation time, hospitalization time and drainage tube removal days of the continuous suture group were shorter than those of the intermittent suture group, and the intraoperative blood loss less than that of the intermittent suture group, visual analogue scale (VAS) were lower than that of the intermittent suture group, the differences were statistically significant (P < 0.05). The scores and total scores of gastrointestinal quality of life index (GIQLI) of the two groups 14 days after operation were higher than those before operation, and the continuous suture group was higher than that of the intermittent suture group. The levels of serum interleukin-6 (IL-6), procalcitonin (PCT), adrenocorticotropic hormone (ACTH), cortisol (Cor), norepinephrine (NE), C- peptide (C-P) and peripheral blood neutrophil (NEUT) 3 days after operation of the two groups were higher than those before operation, while the continuous suture group was lower than that of the intermittent suture group, and the differences were statistically significant (P < 0.05). There were no significant differences in the total incidence of complications, residual rate of stones and recurrence rate of stones between the two groups (P > 0.05).Conclusion The application of continuous suture in primary suture of laparoscopic common bile duct exploration can improve operation-related indexes, relieve postoperative inflammatory reaction and stress response, and improve the quality of life of patients, without increasing the risk of stone residue and recurrence.