Effects of three suture techniques on complications after choledochojejunostomy
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摘要:
目的观察不同缝合方式患者胆肠吻合术后并发症的发生率。方法回顾性分析2005年1月-2014年12月湖北医药学院附属十堰市人民医院收治的162例行胆肠吻合术患者的临床资料,其中68例行单纯间断缝合(称为A组),45例行单纯连续缝合(称为B组),49例行降落伞式连续缝合(称为C组)。比较3组患者术中情况和术后并发症的发生。计量资料组间比较采用方差分析,进一步两两比较采用LSD-t检验,计数资料组间比较采用χ2检验。结果 3组患者胆肠吻合时间和T管放置率的差异均有统计学意义(P值均<0.05)。B组和C组胆肠吻合时间要明显短于A组,差异均有统计学意义(P值均<0.001),b、c两组之间差异无统计学意义(p>0.05)。3组患者中A组T管放置率最高,B组次之,C组最低,两两比较差异均有统计学意义(P值均<0.05)。3组患者术后胆漏和胆汁性腹膜炎的发生率比较,差异均无统计学意义(p值均>0.05)。术后6个月复查,3组之间胆道狭窄情况两两比较,差异均有统计学意义(P值均<0.05),A组胆道缩窄幅度最大,C组最小。结论降落伞式连续缝合是一种精细的胆肠缝合方...
Abstract:Objective To observe the effects of different suture techniques on complications after choledochojejunostomy. Methods A retrospective analysis was performed on the clinical data of 162 patients who underwent choledochojejunostomy from January 2005 to December2014 in our hospital. The patients were divided into group A undergoing simple interrupted suture( n = 68),group B undergoing simple continuous suture( n = 45),and group C undergoing parachute type continuous suture( n = 49). The intraoperative conditions and postoperative complications were compared between the three groups. Comparison of continuous data between the three groups was made by ANOVA and pairwise comparison between any two groups was made by LSD t- tests; comparison of categorical data between the groups was made by chi- square test. Results The anastomosis time and the rate of T- tube insertion showed significant differences between the three groups( P < 0. 05). Groups B and C had significantly shorter anastomosis time than group A( P < 0. 001),but there was no significant difference in the anastomosis time between groups B and C( P > 0. 05). Among the three groups,group A had the highest rate of T- tube insertion;group B had the second highest rate; group C had the lowest rate. Significant differences were found between any two groups in the rate of T- tube insertion by pairwise comparison( P < 0. 05). However,there were no significant differences between the three groups in the incidence rates of postoperative bile leakage and choleperitonitis( P > 0. 05). There was significant difference in biliary stricture between the three groups in the follow- up examination 6 months after surgery( P < 0. 001) and the differences analyzed by pairwise comparison were also significant( P < 0. 05). Among the three groups,the degree of biliary stricture in the group A was the highest and that in the group C was the lowest. Conclusion Parachute- type continuous suture is a fine suture technique for choledochojejunostomy,which can reduce the anastomosis time,the rate of T- tube insertion,and the degree of biliary stricture.
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