胆囊三角“V”字形解剖入路在腹腔镜下复杂胆囊切除术患者中的应用效果  

Application effect of"V"shaped anatomical approach of Calot's triangle in patients with laparoscopic complex cholecystectomy

作　　者：魏松伟 张景春[2] WEI Songwei;ZHANG Jingchun(Yiyang Chinese Hospital,Luoyang 471600;the Second Affiliated Hospital of Henan University of Scienceand Technology,Luoyang 450053,China)

机构地区：[1]宜阳县中医院,河南洛阳471600 [2]河南科技大学第二附属医院,河南洛阳450053

出　　处：《临床医学研究与实践》2023年第24期78-81,共4页Clinical Research and Practice

摘　　要：目的 分析胆囊三角“V”字形解剖入路对腹腔镜下复杂胆囊切除术患者应激反应及胆道损伤情况的影响。方法 以随机数字表法将2020年1月至12月100例采取腹腔镜下复杂胆囊切除术治疗的患者分为常规组(50例,传统胆囊三角后侧入路)和观察组(50例,胆囊三角“V”字形解剖入路)。比较两组的临床效果。结果 观察组的手术中转开腹率低于常规组,术中出血量少于常规组,肠鸣音恢复时间、引流管留置时长、手术时长、卧床时长以及住院时长短于常规组(P<0.05)。观察组的术后并发症总发生率显著低于常规组(P<0.05)。术后36、48 h及7 d,观察组的视觉模拟评分法(VAS)评分均显著低于常规组(P<0.05)。术后24 h,两组的C-反应蛋白(CRP)、皮质醇(Cor)、去甲肾上腺素(NE)、前列腺素E_(2)(PGE_(2))、细胞间黏附分子-1(ICAM-1)以及髓过氧化物酶(MPO)水平均升高,但观察组显著低于常规组(P<0.05)。结论 对于腹腔镜下复杂胆囊切除术治疗的患者,选择胆囊三角“V”字形解剖入路可取得理想手术效果。Objective To analyze the effects of"V"shaped anatomical approach of Calot's triangle on stress response and biliary tract injury in patients with laparoscopic complex cholecystectomy.Methods A total of 100 patients treated with laparoscopic complex cholecystectomy from January to December 2020 were divided into routine group(50 cases,traditional posterior approach of Calot's triangle)and observation group(50 cases,"V"shaped anatomical approach of Calot's triangle)by random number table method.The clinical effects of the two groups were compared.Results The conversion rate of laparotomy in the observation group was lower than that in the routine group,the intraoperative blood loss was less than that in the routine group,the recovery time of bowel sounds,the indwelling time of drainage tube,operation time,bed time and hospitalization time were shorter than those in the routine group(P<0.05).The total incidence of postoperative complications in the observation group was significantly lower than that in the routine group(P<0.05).At 36 h,48 h and 7 d after operation,the Visual Analogue Scale(VAS)score of the observation group was significantly lower than that of the routine group(P<0.05).At 24 h after operation,the levels of C-reactive protein(CRP),cortisol(Cor),norepinephrine(NE),prostaglandin E_(2)(PGE_(2)),intercellular adhesion molecules-1(ICAM-1)and myeloperoxidase(MPO)increased in both groups,but those in the observation group were significantly lower than the routine group(P<0.05).Conclusion For patients with laparoscopic complex cholecystectomy,the selection of the"V"shaped anatomical approach of Calot's triangle can achieve ideal surgical results.

关 键 词：腹腔镜下复杂胆囊切除术 传统胆囊三角后侧入路 胆囊三角“V”字形解剖入路 

分 类 号：R657.4[医药卫生—外科学]