连续缝合和间断缝合应用于一期缝合术治疗老年胆总管结石的疗效比较

doi:10.3969/j.issn.1003-9198.2024.06.018

摘要/Abstract

摘要： 目的探讨连续缝合和间断缝合在腹腔镜胆总管探查一期缝合术治疗老年胆总管结石中的操作技巧和临床疗效。方法回顾性分析2020年1月至2023年1月我院肝胆中心应用腹腔镜胆总管探查一期缝合术治疗的276例老年胆总管结石病人的临床资料,其中181例行胆总管倒刺线连续缝合(连续缝合组),95例行胆总管薇乔线间断缝合(间断缝合组)。比较2组一般资料、围手术期相关指标及术后并发症发生情况。结果所有病人均顺利完成腹腔镜手术,无中转手术病例。2组一般资料、胆总管直径、胆总管管壁厚度、结石直径差异均无统计学意义(P＞0.05)。但连续缝合组在手术时间、胆管缝合时间、术中出血量方面明显优于间断缝合组(P<0.05或P<0.01)。术后共7例病人发生胆漏,均通过保持腹腔持续引流顺利恢复,无再次手术病例,但连续缝合组胆漏发生率明显低于间断缝合组(1.1%比5.3%,P=0.037)。随访3~24个月,2组结石残留、结石复发率差异均无统计学意义(P＞0.05)。结论对于老年胆总管结石病人,相较于间断缝合,应用连续缝合的腹腔镜胆总管探查一期缝合术能够缩短手术时间,减少手术并发症,加快术后康复,是一种有效且安全的微创手术方法。

关键词: 胆总管结石, 一期缝合, 连续缝合, 间断缝合, 老年人

Abstract: Objective To explore the operation skills and clinical effects of continous suture and intermittent snture for laparoscopic common bile duct exploration with primary suture in the treatment of elderly patients with common bile duct stones. Methods The clinical data of 276 elderly patients with common bile duct stones treated by laparoscopic common bile duct exploration with primary suture in our center from January 2020 to January 2023 were retrospectively analyzed, including 181 cases of continuous suture with barb suture (continuous suture group) and 95 cases of intermittent suture with vicryl suture (intermittent suture group). The general data, perioperative related indexes and the incidence of postoperative complications were compared between the two groups. Results All laparoscopic surgery had been successfully completed, without any case of conversion. There were no statistical differences in general data, the diameter of common bile duct, the thickness of common bile duct wall and the diameter of stones between the two groups (P>0.05). The operation time, the time of bile duct suture and operation bleeding volume in continuous suture group were better than those in intermittent suture group (P<0.05 or P<0.01). Seven cases with bile leakage were recovered by continuous drainage, but the incidence rate of bile leakage in continuous suture group was less than that in intermittent suture group (1.1% vs 5.3%, P=0.037). After 3-24 months of follow-up, there were no significant differences in the residual rate of stone and recurrence rate of cholecystolithias between the two groups. Conclusions Compared with intermittent suture, laparoscopic common bile duct exploration with primary suture by continuous suture is an effective and safe minimally invasive surgery for the elderly patients with common bile duct stones, which can shorten the operation time, reduce the complications, and accelerate the postoperative recovery.

Key words: common bile duct stone, primary suture, continuous suture, intermittent suture, aged

中图分类号:

R657.42

胡元昌, 石毅, 白剑峰, 高骥. 连续缝合和间断缝合应用于一期缝合术治疗老年胆总管结石的疗效比较[J]. 实用老年医学, 2024, 38(6): 621-624.

HU Yuanchang, SHI Yi, BAI Jianfeng, GAO Ji. Comparison of the therapeutic effects of continuous suture and intermittent suture in the treatment of elderly patients with choledocholithiasis by primary suture[J]. Practical Geriatrics, 2024, 38(6): 621-624.

参考文献

[1] 李增辉, 王浩龙, 何万民, 等. 腹腔镜胆总管探查术治疗老年胆总管结石的有效性与安全性研究[J]. 中国临床医生杂志, 2019, 47(11):1305-1307.
[2] ZHU J S, TU S J, YANG Z J, et al. Laparoscopic common bile duct exploration for elderly patients with choledoch-olithiasis: a systematic review and meta-analysis[J]. Surg Endosc, 2020, 34(4):1522-1533.
[3] 朱江源, 葛贤秀, 王飞, 等. 内镜逆行胰胆管造影术用于老年胆总管结石效果及术后并发症的危险因素分析[J]. 中国内镜杂志, 2021, 27(2):61-66.
[4] 沈江伦, 李昊楠, 郑晶晶, 等. 两种手术方案在老年胆囊结石并发胆总管结石的疗效对比[J]. 国际老年医学杂志, 2020, 41(4):234-236.
[5] 于久飞, 翟莉莉, 白启轩, 等. 经内镜逆行胰胆管造影术治疗老年胆总管结石的临床疗效[J]. 中国老年学杂志, 2017, 37(11):2734-2736.
[6] 冯永恒, 赵思齐, 周琎, 等. 腹腔镜下胆总管一期缝合在老年胆总管结石病人中的应用效果[J]. 实用老年医学, 2022, 36(9):929-932.
[7] 张小强, 李仓, 朱骄一, 等. 腹腔镜胆总管切开取石一期缝合在老年胆总管结石患者中的应用[J]. 肝胆胰外科杂志, 2023, 35(4):239-241.
[8] KIVIVUORI A, MATTILA L, SIIKI A, et al. Wait-and-see strategy is justified after ERCP and endoscopic sphincterotomy in elderly patients with common biliary duct stones[J]. J Trauma Acute Care Surg, 2023, 94(3):443-447.
[9] 邢人伟, 聂寒秋, 张阳, 等. 老年患者腹腔镜胆总管一期缝合与留置T管治疗胆囊结石合并胆总管结石的临床疗效分析[J]. 中国内镜杂志, 2020, 26(6):25-29.
[10] 刘天旋, 郑楚发, 黄耀奎, 等. LCBDE术后一期缝合与T管引流治疗老年胆总管结石的效果比较[J]. 肝胆胰外科杂志, 2021, 33(7):392-395.
[11] 吴东东, 王尚毓. 腹腔镜胆管一期缝合在胆总管直径正常的老年胆总管结石患者中的应用[J]. 腹腔镜外科杂志, 2022, 27(12):908-912.
[13] 张福, 陈俊卯, 梁晓辉. LCBDE术一期缝合治疗胆总管结石患者效果研究[J]. 实用肝脏病杂志, 2023, 26(1):128-131.
[14] 李文兵, 姜丽娜, 王路兵, 等. 胆囊结石合并胆总管结石行腹腔镜胆总管探查一期缝合术后发生胆道并发症的影响因素[J]. 腹腔镜外科杂志, 2023, 28(2):113-117.

[1]	丛晓飞, 李铭麟, 石春来. 老年口腔衰弱与多重用药的关系及干预策略[J]. 实用老年医学, 2024, 38(9): 872-875.
[2]	李毛毛, 张飞, 沈鑫, 李洁华. 老年人口腔衰弱与跌倒关系的研究进展[J]. 实用老年医学, 2024, 38(9): 876-879.
[3]	张飞, 李毛毛, 李铭麟, 王佳贺. 老年人口腔衰弱与抑郁症的相关性研究进展[J]. 实用老年医学, 2024, 38(9): 884-888.
[4]	李江, 邱雁, 王婷, 王丹, 虞一帆, 濮玲丽, 卜玲. 老年肺腺癌病人术前全身免疫炎症指数/血清白蛋白与临床病理特征的相关性研究[J]. 实用老年医学, 2024, 38(9): 893-896.
[5]	戴静, 崔焱. 糖化血红蛋白变异性与老年2型糖尿病病人认知功能障碍的相关性分析[J]. 实用老年医学, 2024, 38(9): 931-935.
[6]	张星星, 张海洋, 何小菁, 鲁翔. 不同肥胖指标与老年人糖尿病患病风险的调查研究[J]. 实用老年医学, 2024, 38(9): 940-943.
[7]	倪红艳, 陈云, 张其兵, 马一鸣, 解成兰. 电针对老年病人下肢骨科手术围术期认知功能及炎症因子的影响[J]. 实用老年医学, 2024, 38(9): 944-947.
[8]	李晓敏, 李晓林, 栗杰, 吴蕾, 郝冉冉. 老年病人经肛双气囊小肠镜进镜效率及其影响因素研究[J]. 实用老年医学, 2024, 38(9): 958-961.
[9]	蔡荟萃, 陈燕, 王燕, 叶劲军, 朱钰颖. 多形式健康教育模式联合简易呼吸功能锻炼对老年肺癌放疗病人癌因性疲乏及遵医行为的影响[J]. 实用老年医学, 2024, 38(9): 968-972.
[10]	李湘, 栗萱, 田应选. 肺衰老与慢性呼吸系统疾病研究现状及进展[J]. 实用老年医学, 2024, 38(8): 761-765.
[11]	王小娇, 王宁, 崔宏, 叶童, 王晓明. 运动康复对老年轻中度慢性心力衰竭病人的疗效评价[J]. 实用老年医学, 2024, 38(8): 775-778.
[12]	郝世杰, 邹建鹏, 卫晨, 刘清江. 综合呼吸训练对老年帕金森病病人运动减少型构音障碍的影响[J]. 实用老年医学, 2024, 38(8): 783-787.
[13]	向超, 罗彩东. 心电图avL导联T波变化对老年冠心病病人冠脉狭窄程度的诊断价值[J]. 实用老年医学, 2024, 38(8): 788-791.
[14]	李慧颖, 蔡力力, 朱启伟. 血浆N末端脑钠肽前体对高龄左室肥厚病人预后的预测价值[J]. 实用老年医学, 2024, 38(8): 797-801.
[15]	王新平, 谢柏梅, 卫国, 叶晓莉, 赵亚芸, 谭小田. 老年特发性间质性肺炎病人血清S100A9及sCD163表达水平及临床意义[J]. 实用老年医学, 2024, 38(8): 802-807.