Abstract:

Objective　To study the clinical effect of "three-needle" suture for laparoscopic choledocholithiasis surgery. Methods　Fifty patients with choledocholithiasis treated in Lianyungang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from August 2018 to May 2022 were selected and were divided into an observation group and a control group according to the random number table method, with 25 cases in each group. In the observation group, 13 males and 12 females were (48.62±13.76) years old, and the course of disease was (4.91±1.02) years. In the control group, 12 males and 13 females were (49.35±15.08) years old, and the course of disease was (5.05±1.13) years. All patients underwent laparoscopic choledocholithiasis surgery. The control group underwent conventional choledochal suture, and the observation group underwent "three-needle" suture. The operation time, intraoperative blood loss, postoperative catheterization time, postoperative drainage volume, and hospital stay were compared between the two groups. The levels of procalcitonin (PCT), C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) were detected before and 1 month after operation in two groups. The incidence of complications within 1 month after operation was counted. t test and χ² test were used. Results　The operation related indexes in the observation group were better than those in the control group (all P<0.05). The levels of inflammatory factors were significantly lower in both groups 1 month after operation than those before operation, and those in the observation group were lower than those in the control group [PCT: (1.28±0.21) μg/L vs. (1.42±0.22) μg/L; CRP: (27.34±4.72) mg/L vs. (30.19±5.03) mg/L] (t=2.302 and 2.066, both P<0.05). The liver function indexes of both groups were significantly improved 1 month after operation, and the improvement degree of the observation group was significantly better than that of the control group [ALT: (61.38±10.06) U/L vs. (70.23±12.53) U/L; TBIL: (44.37±7.41) μmol/L vs. (50.43±9.43) μmol/L; AST: (63.25±10.54) U/L vs. (70.61±13.92) U/L] (t=2.754, 2.526, and 2.108; all P<0.05). The total incidence of postoperative complications in the observation group was 12.00% (3/25), which was significantly lower than that in the control group [36.00% (9/25)] (χ²=3.947, P=0.047). Conclusion　"Three-needle" suture for laparoscopic choledocholithiasis surgery is less traumatic, which can effectively reduce the inflammatory response, can promote the liver function recovery, has fewer postoperative complications, and is worthy of clinical promotion.

Key words:

Choledocholithiasis, Laparoscopic surgery, "Three-needle" suture

摘要：

目的　研究“三针法”缝合用于腹腔镜胆总管结石手术的临床效果。方法　选取2018年8月至2022年5月在南京中医药大学附属连云港市中医院治疗的50例胆总管结石患者，按照随机数字表法分为观察组和对照组，各25例。观察组男13例，女12例，年龄（48.62±13.76）岁，病程（4.91±1.02）年。对照组男12例，女13例，年龄（49.35±15.08）岁，病程（5.05±1.13）年。所有患者均实施腹腔镜胆总管结石手术，对照组采用常规胆总管缝合技术，观察组采用“三针法”缝合术。对比两组患者手术时间、术中失血量、术后置管时间、术后引流量及住院时间等手术相关指标，检测两组患者手术前及手术后1个月降钙素原（procalcitonin，PCT）、C反应蛋白（C-reactive protein，CRP）、丙氨酸转氨酶（alanine aminotransferase，ALT）、天冬氨酸转氨酶（aspartate aminotransferase，AST）以及总胆红素（total bilirubin，TBIL）水平，统计两组术后1个月并发症发生情况。采用t检验、χ²检验。结果　观察组手术相关指标均较对照组好（均P<0.05）。两组患者术后1个月炎症因子水平显著低于术前，且观察组低于对照组［PCT：（1.28±0.21）μg/L比（1.42±0.22）μg/L；CRP：（27.34±4.72）mg/L比（30.19±5.03）mg/L］（t=2.302、2.066，均P<0.05）。两组术后1个月肝功能指标均明显改善，且观察组改善程度明显优于对照组［ALT：（61.38±10.06）U/L比（70.23±12.53）U/L；TBIL：（44.37±7.41）μmol/L比（50.43±9.43）μmol/L；AST：（63.25±10.54）U/L比（70.61±13.92）U/L］（t=2.754、2.526、2.108，均P<0.05）。观察组术后并发症总发生率为12.00%（3/25），显著低于对照组的36.00%（9/25）（χ²=3.947，P=0.047）。结论　“三针法”缝合用于腹腔镜胆总管结石手术创伤较小，可有效降低炎症反应，促进肝功能恢复，且术后并发症较少，值得临床推广。

关键词:

胆总管结石, 腹腔镜手术, “三针法”缝合