三孔并胆囊底部悬吊法与传统三孔法腹腔镜胆囊切除术临床对比研究  

Clinical application of three-port and gallbladder base suspension in laparoendoscopic cholecystectomy

作　　者：黄凯歌 朱太阳 陈晨[1] 何领[1] 陈德轩[1] Huang Kaige;Zhu Taiyang;Chen Chen;He Ling;Chen Dexuan(Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院,南京210029

出　　处：《河南外科学杂志》2022年第4期14-18,共5页Henan Journal of Surgery

基　　金：江苏省中医院2019院级创新发展基金(Y2019CX21)。

摘　　要：目的探讨三孔并胆囊底部悬吊法与传统三孔法腹腔镜胆囊切除术(LC)的临床效果。方法前瞻性纳入2019-07-2020-11于南京中医药大学附属医院行LC治疗的患者,根据腹壁戳孔方法分为常规三孔法组(三孔法组)和三孔并胆囊底部悬吊法组(三孔并悬吊组)。比较2组患者的基线资料、术中情况、术后临床指标,以及手术费用。结果共纳入80例患者,每组40例。2组患者的基线资料差异无统计学意义(P>0.05)。2组均成功完成LC手术,无1例中转开腹手术,术后亦未发生胆漏和切口感染。三孔并悬吊组的手术总时间、胆囊剥离时间短于三孔法组,术中胆囊破裂率低于三孔法组,差异均有统计学意义(P<0.05)。2组患者的术中出血量、留置引流管率,以及术后的VAS疼痛评分、首次排气时间、白介素-6(IL-6)和C反应蛋白(CRP)水平、WBC计数、空腹血糖水平、住院时间和手术费用的差异均无统计学意义(P>0.05)。结论与传统三孔法比较,采用三孔并胆囊底部悬吊法实施LC,可显著降低手术难度和胆囊破裂发生率,并利于缩短胆囊剥离时间和LC手术时间。但仍需更大样本量的前瞻性随机对照研究(RCT)予以证实。Objective To investigate and compare the clinical outcomes of three-port combined with gallbladder suspension method and conventional three-port method in laparoscopic cholecystectomy(LC).Methods Patients who underwent LC at the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from July 2019 to November 2020 were prospectively included in this study.They were divided into the conventional three-port group and the three-port combined with gallbladder suspension group according to how to make incisions in the abdominal wall.The baseline data,intraoperative conditions,postoperative clinical indicators,and surgical costs of the two groups were compared.Results A total of 80 patients were included,with 40 patients in each group.There was no statistically significant difference in the baseline data between the two groups(P>0.05).LC was successfully completed in both groups,and no patient underwent conversion to laparotomy.And the postoperative bile leakage and incisional infections did not occur.Shorter total operative time and gallbladder dissection time and lower intraoperative gallbladder rupture rate were found in three-port combined with gallbladder suspension group than those of the conventional three-port group.The differences were all statistically significant(P<0.05).The differences in intraoperative blood loss,rate of the indwelling drainage tube,and postoperative VAS pain score,time to first get gas out of the stomach,interleukin-6(IL-6)and C-reactive protein(CRP)levels,WBC count,fasting blood sugar level,length of stay,and surgical cost were not statistically significant between the two groups(P>0.05).Conclusion Compared with the conventional three-port approach,LC performed with three-port combined with gallbladder suspension method can significantly reduce the difficulty of the procedure and the incidence of gallbladder rupture,and shorten the gallbladder dissection time and LC operative time.But prospective randomized controlled trials(RCT)with larger sample size are needed to va

关 键 词：腹腔镜胆囊切除术 三孔并胆囊底部悬吊法 三孔法 

分 类 号：R657.4[医药卫生—外科学]