腹腔镜下后三角入路联合钝性冷分离在腹腔镜胆囊切除术中预防胆管损伤的效果分析  

Effect analysis of laparoscopic posterior triangular approach combined with passive cold separation in preventing biliary tract injury in laparoscopic cholecystectomy

作　　者：樊晨 郝伟 FAN Chen;HAO Wei(Department of General Surgery,Lingshi Renkang Hospital,Jinzhong 031300,China)

机构地区：[1]灵石仁康医院普通外科,031300

出　　处：《中国实用医药》2024年第7期61-63,共3页China Practical Medicine

摘　　要：目的分析腹腔镜下后三角入路联合钝性冷分离在腹腔镜胆囊切除术中预防胆管损伤的应用效果。方法选取190例接受腹腔镜胆囊切除术治疗的患者,按照手术入路方式不同分为对照组和观察组,每组95例。对照组实施胆囊三角入路,观察组实施腹腔镜下后三角入路联合钝性冷分离。对比两组手术指标、炎症因子[C反应蛋白(CRP)、白细胞介素-6(IL-6)]、肠黏膜屏障功能[血清皮质醇(Cor)、C肽(C-P)、D-乳酸]及并发症发生率。结果观察组手术时间(35.21±5.34)min、术后胃肠功能恢复时间(23.57±2.57)h、住院时间(4.41±1.30)d短于对照组的(62.10±6.57)min、(31.22±2.51)h、(7.60±1.13)d,术中出血量(36.17±5.69)ml少于对照组的(50.22±6.88)ml(P<0.05)。观察组并发症发生率1.05%低于对照组的7.37%,差异具有统计学意义(P<0.05)。术后3 d,观察组血清Cor(214.11±14.09)ng/ml、C-P(0.90±0.12)nmol/L、CRP(8.71±0.50)mg/L、IL-6(69.70±5.15)ng/L、D-乳酸(20.70±2.41)μg/L低于对照组的(252.17±15.10)ng/ml、(1.23±0.30)nmol/L、(11.22±1.16)mg/L、(80.52±4.66)ng/L、(29.55±2.67)μg/L,差异具有统计学意义(P<0.05)。结论在腹腔镜胆囊切除术中,采用后三角入路联合钝性冷分离的入路方式应用价值优于胆囊三角入路方式,可预防胆管损伤,减少并发症,优化手术指标,减轻应激反应,可推广。Objective To analyze the effect of laparoscopic posterior triangular approach combined with passive cold separation in preventing biliary tract injury in laparoscopic cholecystectomy.Methods A total of 190 patients receiving laparoscopic cholecystectomy were selected.According to different surgical approaches,they were divided into a control group and an observation group,each with 95 cases.The control group was given cholecystectomy triangle approach,and the observation group was given laparoscopic posterior triangle approach combined with passive cold separation.The surgical indicators,inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6)],intestinal mucosal barrier function[serum cortisol(Cor),C-peptide(C-P),D-lactic acid]and complication rate were compared between the two groups.Results The observation group had operation time of(35.21±5.34)min,postoperative gastrointestinal function recovery time of(23.57±2.57)h,and hospital stay of(4.41±1.30)d,which were shorter than(62.10±6.57)min,(31.22±2.51)h,and(7.60±1.13)d in the control group;the observation group had less intraoperative blood loss of(36.17±5.69)ml than(50.22±6.88)ml in the control group(P<0.05).The complication rate of the observation group was 1.05%,which was lower than 7.37%of the control group,and the difference was statistically significant(P<0.05).3 d after surgery,the observation group had serum Cor of(214.11±14.09)ng/ml,C-P of(0.90±0.12)nmol/L,CRP of(8.71±0.50)mg/L,of IL-6(69.70±5.15)ng/L,and D-lactic acid of(20.70±2.41)μg/L,which were lower than(252.17±15.10)ng/ml,(1.23±0.30)nmol/L,(11.22±1.16)mg/L,(80.52±4.66)ng/L,and(29.55±2.67)μg/L in the control group.The difference was statistically significant(P<0.05).Conclusion In laparoscopic cholecystectomy,the application value of posterior triangle approach combined with passive cold separation approach is better than that of cholecystectomy triangle approach,which can prevent bile duct injury,reduce complications,optimize surgical indicators,alleviate stress reaction

关 键 词：后三角入路 钝性冷分离 腹腔镜胆囊切除术 胆管损伤 应激反应 

分 类 号：R657.4[医药卫生—外科学]