腹腔镜胆总管切开取石不同缝合方式 对术中夹闭T管致胆漏的影响

The effect of different common bile duct suture methods on biliary leak caused by closing T-tube instantly following laparoscopic common bile duct

摘要:

目的 探讨腹腔镜胆总管切开取石术术中夹闭T管的可行性及其与胆总管缝合方式的关系。方法 选择腹腔镜胆总管切开取石置T管患者152例，随机分为3组，分别采取不同的胆总管缝合方法，术中夹闭T管。观察3组患者术中、术后胆总管内压变化及胆漏情况。结果 胆漏发生率分别为3~0可吸收线间断缝合组13例（26.00%），3~0可吸收线连续缝合组9例（16.98%），3~0 V-lock线连续缝合组0例，差异有显著性（P <0.05）。全部胆漏经腹腔引流痊愈；全组术后无肝外胆管狭窄，无其他严重并发症及死亡。结论 腹腔镜胆总管切开取石术中夹闭T管安全、可行，以3~0V-lock线连续缝合可有效避免术后胆总管压力增高引发胆漏的风险。

Abstract:

【Objective】 To evaluate the feasibility of closing T-tube instantly following laparoscopic common bile duct exploration，and explore the relationship between postoperative biliary leak and intraoperative closing T-tube instantly. 【Methods】 152 patients were closed T-tube instantly following laparoscopic common bile duct exploration and randomly divided into three groups by different common bile duct suture methods with various suture materials. The incidence of intraoperative and postoperative biliary leak were observed in each group, and common bile duct pressure was recorded respectively at the same time. 【Results】 There were 13 cases (26.00%) of bile leakage occurred in 3-0 absorbable thread interrupted suture group, 9 cases (16.98％) in 3-0 absorbable line continuous suture group, and 0 case in 3-0vlock line continuous suture group respectively, comparison of biliary leak rate among three groups were with significant statistical significance (P <0.05). All patients of bile leakage were restoration after simple abdominal cavity drainage and had no extrahepatic bile duct stricture after operation or other serious complications, no death occurred. 【Conclusion】 The approach of intraoperative closing T-tube instantly with 3-0Vlock continuous sutures following laparoscopic choledocholithotomy is safe and feasible, which may effectively avoid the risk of biliary leak caused by increased pressure.