单孔腹腔镜下胆囊切除术在不同胆道变异类型中的临床应用  

Clinical application of single incision laparoscopic cholecystectomy in different types of biliary tract variation

作　　者：徐辉[1] 闫军 张鑫[1] 石明炜 XU Hui;YAN Jun;ZHANG Xin;SHI Ming-wei(Shanxi Medical University,Tai Yuan 030000,China;The First Clinical Medical College of Shanxi Medical University,Tai Yuan 030000,China)

机构地区：[1]山西医科大学,030000 [2]山西医科大学第一临床医学院,030000

出　　处：《现代消化及介入诊疗》2023年第3期295-299,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的本文旨在探讨单孔腹腔镜下胆囊切除术(SILC)术前及术中证实存在胆道变异情况时,与正常胆道类型的疗效对比,以及术者如何通过对应操作以提高SILC有效性及安全性。方法回顾分析2021年1月至2022年6月由山西医科大学第一临床医学院肝胆胰外科同一组医师完成的120例单孔腹腔镜胆囊切除术的临床资料及手术视频,将其分为胆道正常组及胆道变异组各60例,其中胆道变异组包含短胆囊管15例、冗长螺旋胆囊管10例、胆囊管低位汇合16例、肝外胆管变异19例(副右肝管16例、迷走胆管3例)。对两组患者的临床资料包括手术时间、术中出血量、胆道损伤量、出院时间、增孔率、中转开腹率及置管率进行统计学分析。结果胆道变异组平均手术时间(69.7±20.5 min)相比胆道正常组手术时间(61.8±14.8 min)较长,且有统计学意义(P<0.05),但不同胆道类型的SILC的手术时间相比无显著差异(P>0.05)。术中出血量胆道正常组(13.9±3.7 mL)较少,且有统计学意义(P<0.05),术后住院时间差异无统计学意义(P>0.05)。两组行SILC的有效性的差异无统计学意义(P>0.05),其中胆道变异组有1例发生胆道损伤,变异类型为胆囊管低位汇合。结论胆道变异患者行SILC的手术时间较胆道正常患者较长,但其有效性基本无差异。不同胆道类型的手术时间无显著差异。术前评估MRCP,术中提高警惕性,细心处理术中可疑管道有助于术者提高手术安全性。Objective The purpose of this study was to compare the efficacy of single incision laparoscopic cholecystectomy(SILC)with that of normal biliary tract types when biliary tract abnormalities were confirmed before and during the operation,and how to improve the effectiveness and safety of SILC through corresponding operations.Methods The clinical data and surgical videos of 120 cases of single-port laparoscopic cholecystectomy performed by the same group of physicians in the Department of Hepatobiliary and pancreatic Surgery of the First Clinical College of Shanxi Medical University from January 2021 to June 2022 were retrospectively analyzed,and they were divided into the normal biliary tract group and the abnormal biliary tract group with 60 cases each.Among them,the biliary duct variation group included 15 cases of short cystic duct,10 cases of long spiral cystic duct,16 cases of low conjoint cystic duct,19 cases of extra-hepatic bile duct variation(16 cases of accessory right hepatic duct,3 cases of vagal bile duct).The clinical data of the two groups,including operation time,intraoperative blood loss,biliary tract injury,discharge time,porosity increase rate,conversion to laparotomy rate and catheterization rate,were statistically analyzed.Results The mean operation time of biliary tract variation group(69.7±20.5 min)was longer than that of normal biliary tract group(61.8±14.8 min),and had statistical significance(P<0.05),but there was no significant difference in the operation time of different biliary tract types of SILC(P>0.05).The amount of intraoperative blood loss in the normal biliary tract group(13.9±3.7 mL)was less,and had statistical significance(P<0.05),while the postoperative hospitalization time had no statistical significance(P>0.05).There was no significant difference in the effectiveness of SILC between the two groups(P>0.05),among which there was 1 case of biliary tract injury in the biliary tract variant group,and the variant type was low cystic duct confluence.Conclusion The operation tim

关 键 词：腹腔镜 单孔 手术时间 有效性 胆道变异 

分 类 号：R657.4[医药卫生—外科学]