T型入路及动脉先行解剖胆囊三角在腹腔镜胆囊切除术中的应用  

Application of T-approach and arterial dissection of gallbladder triangle in laparoscopic cholecystectomy

作　　者：汪明术 WANG Ming-shu(Surgical Ward 2,Jinzhai Hospital of Traditional Chinese Medicine,Jinzhai 237300,China)

机构地区：[1]金寨县中医医院外科二病区,金寨237300

出　　处：《肝胆外科杂志》2023年第6期453-456,480,共5页Journal of Hepatobiliary Surgery

摘　　要：目的探讨采用"T"字型入路及胆囊动脉先行方法解剖胆囊三角在腹腔镜胆囊切除术中的临床应用价值.方法回顾分析金寨县中医医院2019-2023年期间903例腹腔镜胆囊切除术患者的临床资料,按照胆囊三角的解剖方法不同分为研究组204例(采用"T"字型入路及胆囊动脉先行方法)和对照组699例(采用传统常规解剖方法),比较两组在手术时间、胆囊动脉解剖成功率、术中出血量、Hem-o-lock夹使用量及中转开腹率方面的差异;比较两组术后住院时间、腹腔引流放置率及引流时间、围手术期总并发症、胆道并发症方面的差异.结果两组之间手术时间、中转开腹率、腹腔引流管放置率、术后腹腔内出血率及围手术期总并发症发生率无差异(P>0.05).研究组胆囊动脉解剖成功率(95.6%)高于对照组(84%)(x2=18.346,P<0.05),术中出血量及Hem-o-lock夹使用量低于对照组,均具有统计学差异(P<0.05);研究组术后住院时间、引流管放置病例术后引流时间短于对照组,具有统计学差异(P<0.05);研究组胆道并发症发生率(0)低于对照组(2.58%),具有统计学差异(x2=4.123,P<0.05).结论腹腔镜胆囊切除术中采用"T"字型入路及胆囊动脉先行方法解剖胆囊三角,能提高胆囊动脉解剖成功率,减少术中出血量及Hem-o-lock夹使用量,降低胆道并发症发生率,缩短引流管放置病例的术后引流时间,缩短住院时间,使手术更加安全可靠,术后恢复更快.Objective To investigate the clinical value of dissecting the gallbladder triangle with"T"shaped approach and gallbladder artery in laparoscopic cholecystectomy.Methods The clinical data of 903 cases of laparoscopic cholecystectomy in Jinzhai County Hospital of Traditional Chinese Medicine from 2019 to 2023 were retrospectively analyzed.According to different anatomical methods of the gallbladder triangle,204 cases were divided into the study group(using"T"shaped approach and gallbladder artery first method)and 699 cases were divided into the control group(using traditional anatomical methods).The differences of operation time,success rate of gallbladder artery dissection,intraoperative blood loss,use of Hem-o-lock clamp and conversion rate of laparoto-my were compared between the two groups.The postoperative hospital stay,peritoneal drainage placement rate and drainage time,peri-operative total complications and biliary complications were compared between the two groups.Results There were no differences in operation time,conversion rate,placement rate of abdominal drainage tube,postoperative intra-abdominal bleeding rate and periopera-tive complication rate between the two groups(P>0.05).The success rate of gallbladder artery dissection in the study group(95.6%)was higher than that in the control group(84%)(x2=18.346,P<0.05),and the amount of intraoperative blood loss and the use of Hem-o-lock clip were lower than those in the control group,with statistical differences(P<0.05).Postoperative hospi-talization time and postoperative drainage time in the study group were shorter than those in the control group(P<0.05).The inci-dence of biliary complications in the study group(0)was lower than that in the control group(2.58%),with statistical difference(x2=4.123,P<0.05).Conclusion In laparoscopic cholecystectomy,the dissection of the gallbladder triangle using the"T"shaped approach and the gallbladder artery first method can improve the success rate of gallbladder artery dissection,reduce the amount of intr-aoperativ

关 键 词：腹腔镜胆囊切除术 胆囊三角 胆囊动脉 胆道并发症 

分 类 号：R657.4[医药卫生—外科学]