循A-B-D路径改良腹腔镜胆囊切除术的临床效果研究  

Clinical effects of modified laparoscopic cholecystectomy following“A-B-D”pathway

作　　者：谢青云[1] 高峰畏 雷泽华[1] 蒋康怡 龚杰 赵欣 XIE Qingyun;GAO Feng-wei;LEI Ze-hua;JIANG Kang-yi;GONG Jie;ZHAO Xin(Department of Hepatobiliary Surgery,Leshan Diagnosis and Treatment Center for Systemic Disease,Leshan People’s Hospital,Sichuan 614000,China)

机构地区：[1]乐山市人民医院肝胆外科/乐山市肝胆胰脾系统性疾病诊疗中心,四川乐山614000

出　　处：《肝胆胰外科杂志》2021年第2期65-69,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：四川省卫生健康委科研项目(20PJ296);乐山市科技局2020年重点科技计划项目(20SZD035)。

摘　　要：目的探讨自主创新改良的循A-B-D路径(胆囊动脉artery→胆囊床bed→胆囊管duct)腹腔镜胆囊切除术(LC)的技术特点及临床应用价值。方法回顾性分析乐山市人民医院2017年1月至2019年9月收治的2103例行LC的患者临床资料。按照术中手术方法的不同分为两组,循A-B-D路径改良LC组879例,经典LC组1224例,术后随访6~24个月。比较分析两组中转开腹率、手术时间、术中出血量、医源性肝外胆管损伤、术后住院时间、术后近期和远期并发症发生率等指标差异。结果循A-B-D路径改良LC组术中医源性胆管损伤发生率[0 vs 0.49%(6/1224)]和远期残余胆囊结石伴胆囊炎发生率[0.23%(1/433)vs 1.51%(8/529)]均低于经典LC组,差异均存在统计学意义(P<0.05),而两组在手术时间、术中出血量、中转开腹率、术后住院时间、术后出血、胆漏、腹腔感染、消化不良症状、腹腔残余感染、胆管炎、胆管狭窄、胆管结石等方面,差异均无统计意义(P>0.05)。结论循A-B-D路径改良LC术作为手术技术的改进在临床应用安全、可靠;作为手术理念的改进及手术步骤的优化,可最大程度避免医源性胆管损伤及残余胆囊结石伴胆囊炎的发生,具有良好的基层应用推广前景。Objective To explore the technical characteristics and clinical value of laparoscopic cholecystectomy(LC)via A-B-D pathway(artery→bed→duct).Methods The clinical data of 2103 patients who underwent from Jan.2017 to Sep.2019 in Leshan People’s Hospital were analyzed retros-pectively.Patients were divided into two groups:modified LC group(n=879)and classical LC group(n=1224).Patients were followed-up for 6 to 24 months.The two groups were compared in terms of conversion rate,operation time,intraoperative blood loss,iatrogenic extrahepatic bile duct injury,postoperative hospitalization time and the incidence of short-term and long-term complications.Results The incidences of iatrogenic bile duct injury[0 vs 0.49%(6/1224)]and long-term residual cholecystolithiasis with cholecystitis[0.23%(1/433)vs 1.51%(8/529)]in the modified LC group were lower than those in the classical LC group,the differences were statistically significant(P<0.05).The differences were not statistically significant in terms of operation time,intraoperative blood loss,conversion to laparotomy rate,postoperative hospitalization time,postoperative bleeding,bile leakage,abdominal infection,dyspeptic symptoms,abdominal residual infection,cholangitis,bile duct stricture,or bile duct stones(P>0.05).Conclusion As an improvement of surgical technique,modified LC via A-B-D path is safe and reliable in clinical application;as an improvement of surgical concept and optimization of surgical procedures,modified LC can avoid iatrogenic biliary tract injury and residual cholecystolithiasis with cholecystitis to the greatest extent,thus has a good prospect of grass-roots application.

关 键 词：改良腹腔镜胆囊切除术 胆囊动脉→胆囊床→胆囊管路径(A-B-D路径) 胆管损伤 残余胆囊结石 

分 类 号：R657.4[医药卫生—外科学]