不同解剖入路预防腹腔镜复杂胆囊切除术中胆道损伤的临床应用价值研究

摘要/Abstract

摘要： 目的研究不同解剖入路预防腹腔镜复杂胆囊切除术中胆道损伤的临床应用价值。方法选取2019年1月~2022年3月淮安市淮阴医院及淮安市第五人民医院收治的125例行腹腔镜复杂胆囊切除术患者作为研究对象,按照随机数表法分为对照组与观察组,其中对照组65例,观察组60例。对照组患者在手术过程中行常规手术入路进行腹腔镜下胆囊切除术,观察组行胆囊三角V字型解剖入路腹腔镜下胆囊切除术。比较两组患者手术情况、相关实验室检查指标、并发症发生率以及术后恢复情况。结果观察组患者手术时间短于对照组,术中出血量以及中转开腹率均明显低于对照组,差异有统计学意义（P<0.05）;术后,两组患者体温、谷草转氨酶（AST）、白细胞（WBC）、直接胆红素（DBIL）、谷丙转氨酶（ALT）、间接胆红素（IBIL）、中性粒细胞百分比（NEU%）水平均低于术前,差异有统计学意义（P<0.05）;术后,两组患者体温、AST、WBC、DBIL、ALT、IBIL、NEU%指标水平比较,差异无统计学意义（P>0.05）;两组患者术后并发症发生率比较,差异无统计学意义（P>0.05）;观察组患者平均术后引流管留置时间、术后排气时间和住院时间、住院费用均明显少于对照组,差异有统计学意义（P<0.05）。结论腹腔镜复杂胆囊切除术患者在手术过程中采取胆囊三角V字型解剖入路,可减少手术时间与中转开腹率,降低手术胆道损伤、胆漏等并发症的发生率,降低患者住院费用,疗效显著,值得临床应用。

关键词: V字型解剖入路, 腹腔镜, 复杂胆囊切除术, 胆道损伤

Abstract: Objective To explore the value of different anatomical approaches in the prevention of biliary tract injury and its clinical application in laparoscopic complex cholecystectomy. Methods From January 2019 to March 2022, Huai’an Huaiyin Hospital and Huai’an Fifth People’s Hospital were selected. A total of 125 patients undergoing laparoscopic complex cholecystectomy were divided into control group (n=65) and observation group (n=60) according to random number table method. Patients in the control group underwent conventional surgical approach for laparoscopic cholecystectomy, while patients in the observation group underwent laparoscopic cholecystectomy through V-shaped anatomical approach of the gallbladder triangle. The operation conditions, relevant laboratory examination indexes, incidence of complications and postoperative recovery were compared between the two groups. Results The operation time, intraoperative blood loss and conversion rate of the observation group were significantly lower than those of the control group, and the differences were statistically significant (P<0.05). After operation, the levels of body temperature, aspartate aminotransferase (AST), white blood cell (WBC), direct bilirubin (DBIL), alanine aminotransferase (ALT), indirect bilirubin (IBIL) and neutrophil percentage (NEU%) in the two groups were lower than those before operation, and the differences were statistically significant (P<0.05). After operation, there were no significant differences in body temperature, AST, WBC, DBIL, ALT, IBIL and NEU% between the two groups (P>0.05). There was no significant difference in postoperative complications between the two groups (P>0.05). The average postoperative drainage tube indwelling time, postoperative exhaust time, hospitalization time and hospitalization cost of the observation group were significantly lower than those of the control group, and the differences were statistically significant (P<0.05). Conclusion The gallbladder triangle V-shaped anatomical approach in the process of laparoscopic complex cholecystectomy can reduce the operation time and conversion rate to open surgery, reduce the incidence of complications such as biliary tract injury and biliary leakage, reduce the cost of hospitalization, the curative effect is significant, worthy of clinical application.

Key words: V font anatomical approach, laparoscope, complex cholecystectomy, biliary tract injury

中图分类号:

R657.4

鲍仲明, 张华国. 不同解剖入路预防腹腔镜复杂胆囊切除术中胆道损伤的临床应用价值研究[J]. 中华养生保健, 2022, 40(22): 8-11.

BAO Zhong-ming, ZHANG Hua-guo. Clinical Value of Different Anatomical Approaches in Preventing Biliary Tract Injury in Laparoscopic Complex Cholecystectomy[J]. ZHONGHUA YANGSHENG BAOJIAN, 2022, 40(22): 8-11.

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