腹腔镜胆囊切除术中经剑突单孔体内绕线结扎胆囊动脉、胆囊管的临床应用效果  

Clinical application of ligation of cystic duct and cystic artery via xiphoid single pore in vivo during laparoscopic cholecystectomy

作　　者：周泉宇 贺伟 刘尧 廖波 梁勇 夏雨霄 ZHOU Quanyu;HE Wei;LIU Yao;LIAO Bo;LIANG Yong;XIA Yuxiao(Department of Hepatobiliary Surgery,Chengdu 363 Hospital Affiliated to Southwest Medical University,Chengdu,Sichuan 610041,China;Department of Nuclear Medicine,China National Nuclear Corporation 416 Hospital,Chengdu,Sichuan 610000,China)

机构地区：[1]西南医科大学附属三六三医院肝胆外科,四川成都610041 [2]核工业四一六医院核医学科,四川成都610066

出　　处：《肝胆胰外科杂志》2023年第12期742-746,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：中国核工业集团公司青年人才计划项目(C N N C2021137);四川省科技创新创业苗子工程项目(2021JDRC0170);成都医学院自然科学基金项目(20Z101)。

摘　　要：目的初步探讨腹腔镜胆囊切除术(LC)中,采用经剑突单孔体内绕线结扎与生物夹夹闭胆囊动脉、胆囊管的临床应用效果差异。方法采用回顾性病例对照研究方法,收集分析2021年1月至2021年12月西南医科大学附属三六三医院接受LC的1226例患者的临床资料。研究组(n=513)行经剑突单孔体内绕线结扎胆囊动脉、胆囊管的改良法,对照组(n=713)采用生物夹夹闭胆囊动脉、胆囊管的传统方法。比较两组患者的术中、术后情况及随访结果。结果与对照组相比,研究组手术时间更短[(44.49±12.15)min vs(59.54±28.28)min,P=0.001],住院费用更少[(1.09±0.29)万元vs(1.41±0.19)万元,P=0.001],术中胆管损伤更少[0 vs 0.84%(6/713),P=0.037],差异均有统计学意义。但两组患者术中出血量、术后引流管放置、中转开腹、住院时间差异均无统计学意义(P>0.05)。研究组与对照组术后出血[0.58%(3/513)vs 1.54%(11/713)]、胆瘘[1.36%(7/513)vs 1.40%(10/713)]、腹腔感染[1.94%(10/513)vs 2.24%(16/713)]发生率差异无统计学差异(P>0.05)。结论相较于传统结扎方式,LC术中采用经剑突单孔体内绕线结扎胆囊动脉、胆囊管的改良结扎法安全、可靠,不增加硬件设备及人力成本,在基层医院具有一定的应用推广价值。Objective To compare the clinical outcomes of two different surgical techniques in laparoscopic cholecystectomy(LC):ligation of the cystic artery and cystic duct through a xiphoid single pore,and closure of the cystic artery and cystic duct using a biological clamp.Methods A retrospective case-control study was conducted to analyze the clinical data of 1226 patients who underwent laparoscopic cholecystectomy(LC)at Chengdu 363 Hospital Affiliated to Southwest Medical University between Jan.2021 and Dec.2021.The study group(n=513)underwent an improved method of ligation of the cystic artery and cystic duct through xiphoid single foramina,while the control group(n=713)underwent the traditional method of biological clamp.The researchers compared the intraoperative,postoperative,and follow-up results between the two groups.Results In comparison to the control group,the study group exhibited statistically significant reductions in operative time[(44.49±12.15)min vs(59.54±28.28)min,P=0.001],intraoperative bile duct injury[0 vs 0.84%(6/713),P=0.037],and hospitalization costs[(10900±2900)yuan vs(14100±1900)yuan,P=0.001].However,no significant differences were observed between the two groups in terms of blood loss,postoperative drainage tube placement,conversion to laparotomy,and hospitalization time(P>0.05).There were no statistically significant disparities observed in the occurrence of postoperative hemorrhage[0.58%(3/513)vs 1.54%(11/713)],biliary fistula[1.36%(7/513)vs 1.40%(10/713)],and abdominal infection[1.94%(10/513)vs 2.24%(16/713)]between the study group and control group(P>0.05).Conclusion The enhanced technique of ligating the cystic artery and cystic duct through a single hole in the xiphoid process,as compared to conventional ligation methods,exhibits a commendable level of safety and reliability.Moreover,this method does not entail additional expenses for hardware equipment or labor,thereby presenting a promising application potential within basic hospital settings.

关 键 词：腹腔镜胆囊切除术 剑突 单孔 体内绕线 结扎 胆囊动脉 胆囊管 

分 类 号：R657.4[医药卫生—外科学]