经耻骨联合上入路腹腔镜胆囊切除术的应用价值  

Value of laparoscopic cholecystectomy through the superior margin of public symphysis approach

作　　者：桑宏阳 李宏[1] 

机构地区：[1]宁波市医疗中心李惠利医院腹部微创外科,315211

出　　处：《中华消化外科杂志》2014年第5期341-344,共4页Chinese Journal of Digestive Surgery

基　　金：宁波市医学科技计划项目（A）（2009A03）

摘　　要：目的探讨经耻骨联合上入路Lc的应用价值。方法回顾性分析2012年12月至2013年8月宁波市医疗中心李惠利医院收治的72例胆囊良性疾病患者的临床资料，其中胆囊结石54例，胆囊息肉18例。30例经耻骨联合上人路行LC（新方法组）；42例行单孔LC（单孔组）。比较两组患者的手术时间、术中出血量、术后住院时间、术后疼痛程度、术后切口满意程度和美容效果。采用门诊复查或电话随访，随访时间截至2013年12月。计量资料采用独立样本t检验，计数资料采用，检验。结果新方法组2例患者改行传统Lc，单孔组1例患者改行传统Lc，其余患者均顺利完成手术。新方法组患者手术时间、术中出血量、术后住院时间、术后切口满意程度、术后疼痛程度分别为（28±3）min、（23±10）mL、（2．0±0．5）d、（4．3±0．5）分、（5．8±0．8）分；单孔组分别为（39±4）min、（24±10）mL、（2．0±0．6）d、（3．9±0．5）分、（5．9±0．9）分，两组患者手术时间、术后切口满意程度比较，差异有统计学意义（t=10．032，2．423，P〈0．05）；术中出血量、术后住院时间、术后疼痛程度比较，差异无统计学意义（t=1．021，0．000，1．760，P〉0．05）。所有手术患者术后恢复良好，术后第2天进半流质饮食，术后无出血、胆汁漏、切口感染等并发症发生，无围手术期死亡。两组患者术后均未使用镇痛药物。所有患者获得随访，随访时间1～6个月。患者对术后切口满意程度较高，切口无炎症反应、疼痛、感染等并发症发生。结论经耻骨联合上入路LC安全、可行，术后瘢痕隐蔽、不明显，与单孔Lc比较，手术时间短、操作容易、患者对术后切口满意程度高。Objective To investigate the value of laparoscopic cholecystectomy through superior margin of public symphysis approach. Methods The clinical data of 72 patients with benign gallbladder diseases who were admitted to the Lihuili Hospital from December 2012 to August 2013 were retrospectively analyzed. There were 54 patients with cholecystolithiasis and 18 with gallbladder polyps. Thirty patients received laparoscopic cholecystectomy through the superior margin of public symphysis approach （ new method group）. Forty-two patients who received transumbilical single-port laparoscopic cholecystectomy were in the control group. The operation time, intraopera- tire blood loss, duration of postoperative hospital stay, degree of postoperative pain and cosmetic effect of the 2 groups were compared. Patients were followed up via out-patient examination and phone call till December 2013. Data were analyzed using the t test or chi-square test. Results Two patients in the new method group and 1 patient in the control group were converted to receive traditional laparoscopic cholecystectomy. The operation time, intraoperative blood loss, duration of postoperative hospital stay, scores of satisfaction with the incision and degree of postoperative pain were （28 ±3 ） minutes, （23 ± 10） mL, （2.0 ±0.5 ） days, 4.3 ± 0.5 and 5.8 ± 0.8 in the new method group, and （39 ±4） minutes, （24 ± 10） mL, （2.0 ± 0.6） days, 3.9 ±0.5 and 5.9 ± 0.9 in the control group. There were significant differences in the operation time and score of satisfaction with the incision between the 2 groups were detected （t = 10. 032, 2. 423, P 〈0.05）, while no significant differences in the volume of intraoperative blood loss, duration of postoperative hospital stay and degree of pain between the 2 groups （ t = 1. 021, 0. 000, 1. 760, P 〉0.05）. All the patients were recovered, and were administered with semi-fluid food at postoperative day 2. No bleeding, bile leakage, incisional infection occurred, and no patient died

关 键 词：胆囊良性疾病 胆囊切除术 腹腔镜检查 经耻骨联合入路 

分 类 号：R657.4[医药卫生—外科学]