腹腔镜胆囊次全切除术在腹腔镜困难胆囊切除术中的应用  

Application of laparoscopic subtotal cholecystectomy in laparoscopic difficult cholecystectomy

作　　者：李殿启 刘栋 李健 赵晓光 王浩 Li Dianqi;Liu Dong;Li Jian;Zhao Xiaoguang;Wang Hao(Department I of Surgery, No.413 Hospital of People's Liberation Army, Zhoushan 316000, China;Department of Surgery, Navy Peace Ark Hospital of People's Liberation Army, Zhoushan 316000, China)

机构地区：[1]解放军413医院外一科,浙江省舟山市316000 [2]中国人民解放军海军和平方舟医院外科,浙江省舟山市316000

出　　处：《中华肝脏外科手术学电子杂志》2017年第6期469-473,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜困难胆囊切除术中改行腹腔镜胆囊次全切除术(LSC)的临床疗效和安全性。方法回顾性分析2011年1月至2016年11月在解放军413医院诊治的58例腹腔镜胆囊切除术(LC)术中改变术式患者临床资料。根据患者中转术式的不同,将患者分为LSC组和开腹胆囊切除术组(OC组)。其中LSC组31例,男13例,女18例;平均年龄(57±18)岁。OC组27例,男12例,女15例;年龄(54±16)岁。患者均签署知情同意书,符合医学伦理学规定。LSC组患者在腹腔镜下改为顺行或逆行切除胆囊,保留胆囊后壁。OC组采用右侧肋缘下斜切口行OC。术后对患者进行随访,两组患者手术时间、术中出血量、术后疼痛评分、引流管留置时间、住院时间比较采用t检验,术后并发症发生率比较采用χ~2检验。结果 LSC组患者手术时间、术中出血量分别为(68±10)min、(56±11)ml,明显低于OC组的(89±13)min、(81±28)ml(t=-7.2,-4.5;P<0.05)。LSC组患者术后疼痛评分、引流管留置时间、住院时间分别为(3.1±0.8)分、(61±12)h、(4.8±1.8)d,明显低于OC组的(5.4±0.9)分、(73±14)h、(7.5±2.3)d(t=-10.3,-3.6,-5.0;P<0.05)。LSC组术后并发症发生率为10%(3/31),OC组为22%(6/27),差异无统计学意义(χ~2=1.73,P>0.05)。两组患者术后均未发生死亡。结论对于腹腔镜困难胆囊切除术患者,与OC相比,LSC的手术时间更短、术中出血量更少、手术安全性更高,有利于患者术后康复。Objective To evaluate the clinical efficacy and safety of laparoscopic subtotalcholecystectomy(LSC)in laparoscopic difficult cholecystectomy.Methods Clinical data of58patients who were converted to other operation procedure during laparoscopic cholecystectomy(LC)inNo.413Hospital of People's Liberation Army between January2011and November2016were analyzedretrospectively.According to different converted operation,the patients were divided into LSC group andopen cholecystectomy group(OC group).There were31cases in LSC group,13males and18females,with an average age of(57±18)years and27in OC group,12males and15females,with an average age of(54±16)years.The informed consents of all patients were obtained and the local ethical committee approvalwas received.Patients in LSC group were converted to laparoscopic antegrade or retrograde cholecystectomy,and the posterior gallbladder wall was retained.Patients in OC group underwent OC through the rightsubcostal incision.All the patients were followed up after operation.The operation time,intraoperativebleeding volume,postoperative pain score,drainage duration and length of hospital stay in both groupswere compared by t test,and the incidence of postoperative complications was compared by Chi-squaretest.Results The operation time and intraoperative bleeding volume in LSC group were(68±10)min and(56±11)ml,significantly lower than(89±13)min and(81±28)ml in OC group(t=-7.2,-4.5;P<0.05).Thepostoperative pain score,drainage duration and length of hospital stay in LSC group were(3.1±0.8)min,(61±12)h and(4.8±1.8)d,significantly lower than(5.4±0.9)min,(73±14)h and(7.5±2.3)d in OC group(t=-10.3,-3.6,-5.0;P<0.05).The incidence of postoperative complications was10%(3/31)in LSC groupand22%(6/27)in OC group,and no significant difference was observed(χ2=1.73,P>0.05).No postoperativedeath occurred in both groups.Conclusions For patients undergoing laparoscopic difficult cholecystectomy,compared with OC,LSC presents advantages of shorter operation time,less intraoperative bleedin

关 键 词：腹腔镜 胆囊切除术 失血 手术 手术后并发症 

分 类 号：R657.4[医药卫生—外科学]