| Objective:To investigate the application effect of several different suture materials in the reconstruction of bilioenteric anastomosis and their influence on postoperative complications,and to select the appropriate suture materials for clinical biliary tract reconstruction.Methods:The medical records and follow-up data of patients who underwent bilioenteric anastomosis for various reasons in the Department of Hepatobiliary Surgery of our hospital from January 2020 to June 2022 were retrospectively collected by searching the key words of "bilioenteric drainage and choledochojejunostomy" in the electronic medical record system of our hospital.A total of 157 patients met the inclusion criteria,including 127 cases in absorbable suture group,85 cases in Vicryl Plus group,42 cases in PDS-Ⅱ group,and 30 cases in Prolene group.The patients were divided into absorbable suture group and non-absorbable suture group according to the absorbable property of suture.The three groups(Vicryl Plus+ intermittent suture,PDS-Ⅱ+ continuous suture,Prolene+ continuous suture)were compared and analyzed.The observation indicators of each group were compared and analyzed,including preoperative general baseline data,intraoperative data(bilioenteric anastomosis suture time,operation time,intraoperative blood loss),and postoperative data(postoperative bile leakage,anastomotic stenosis and other complications).SPSS25.0 data analysis software was used to calculate and analyze the above data to explore and find the best suture line for bilioenteric anastomosis.Results:Complications in the absorbable suture group: 5 cases occurred in 127 cases,accounting for 3.9% of the total.Bile leakage occurred in 4 cases(80%).Biliary calculi occurred in 1 case(20%).In Vicryl Plus group,complications occurred in 4 cases(4.7%),including 3 cases of bile leakage(75%)and 1 case of bile duct stone(25%).There were 42 patients in PDS-Ⅱ group,and 1 patient(2.4%)had postoperative complications.Bile leakage occurred in 1 case,and other complications did not occur.There were 30 cases in Prolene group,3 cases occurred,accounting for 10% of the total.The incidence of bile leakage was 0,bile duct stone was 33.3%,anastomotic stenosis was 66.7%.There was a significant difference in anastomotic stenosis between the two groups(P=0.003 < 0.05).As well as bilioenteric anastomosis time(15.3(12.5,16.9)min VS 12.7(11.3,15.13)min)and ALB on the first postoperative day(32.1(28.5,35.4)g/l VS 29.55(25.93,33.13))g/l)were significantly different(P < 0.05).There was a significant difference in the incidence of anastomotic stenosis between Prolene group and Vicryl Plus group(P=0.014 < 0.05).Prolene group was compared with PDS-Ⅱ group,Vicryl Plus was compared with PDS-Ⅱ group.The difference was not statistically significant(P > 0.05).The time of choledochojejunostomy was16.3(13.95,17.3)min in Vicryl Plus group and 16.3(13.95,17.3)min in PDS-Ⅱ group.12.5(10.88,14.9)min in Vicryl Plus group,12.7(11.3,15.13)min in Prolene group),ALB on postoperative day 1(32.6(28.9,36.4)g/l in Vicryl Plus group;Group PDS-Ⅱ 28.8(26.7,32.75)g/l;29.55(25.93,33.13)g/l)in Prolene group,the difference between Vicryl Plus group and PDS-Ⅱ group and Prolene group was statistically significant(P < 0.05).Conclusion:There was no significant difference in the incidence of postoperative bile leakage between the absorbable group and the non-absorbable group,and there was no significant difference in the incidence of postoperative bile leakage between the three groups.The incidence of anastomotic stricture in absorbable group was better than that in non-absorbable group,and Prolene was worse than Vicryl Plus.There was no significant difference between Vicryl Plus group and PDS-Ⅱ group.Under the same condition,PDS-Ⅱ continuous suture can save the time of choledochojejunostomy.Further studies with larger sample size and better postoperative follow-up are needed for long-term complications. |
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