基层医院处理困难腹腔镜胆囊切除术521例体会  

Experience on 521 cases of difficult laparoscopic cholecystectomy in grassroots hospital

作　　者：李昆仑[1] 赵华[1] LI Kunlun;Zhao Hua(Department of Hepatobiliary Surgery,Zhoukou Central Hospital,Zhoukou,Henan 466000,China)

机构地区：[1]周口市中心医院肝胆外科,河南周口466099

出　　处：《肝胆胰外科杂志》2024年第5期287-293,共7页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨基层医院处理困难腹腔镜胆囊切除术(LC)的手术技巧,提高处理复杂胆囊的成功率和安全性。方法对2020年5月至2023年11月周口市中心医院共完成的2862例LC患者的病例资料进行回顾性分析。其中常规LC 2341例(CLC组),困难LC 521例(DLC组)。DLC组实施腹腔镜胆囊次全切除术340例,腹腔镜胆囊全切除术181例。结果与CLC组比较,DLC组手术时间更长[(120.6±20.5)min vs(30.2±15.8)min]、术中出血量更多[(90.5±10.2)mL vs(20.5±3.5)mL]、术后住院时间更长[(13.2±1.5)d vs(3.0±0.7)d]、术后胆漏发生率更高[2.88%(15/521)vs 0.04%(1/2341)],差异均有统计学意义(均P<0.05),但两组住院费用[(1.31±0.03)万元vs(1.28±0.03)万元]差异无统计学意义(P>0.05)。两组术中均未出现胆管及门静脉损伤,DLC组术后胆瘘15例,其中12例引流2周左右痊愈,另外3例胆瘘较重,加行鼻胆管引流后痊愈。DLC组中行胆囊次全切除患者较行胆囊全切除的患者的手术时间更短[(106.7±14.4)min vs(134.5±22.9)min]、术中出血量更少[(77.2±10.5)mL vs(103.8±16.8)mL]、引流管留置时间更短[(4.1±0.8)d vs(7.9±1.7)d]、术后住院时间更短[(11.4±1.5)d vs(15.0±0.7)d]、胃肠道恢复时间更短[(1.6±0.6)d vs(2.8±1.0)d],差异均有统计学意义(均P<0.05)。随访1年,两组均未出现相关手术并发症。结论胆囊次全切除术在困难LC中具有副损伤小、术后恢复快、术后严重并发症少等优势,可以成为处理复杂胆囊的一种安全可行有效的手术方法选择。在把握好手术时机,掌握困难LC的手术难点与技巧的前提下,在具有丰富的LC技术的基层医院,行LC处理复杂胆囊是安全可行的。Objective To explore the surgical techniques for difficult laparoscopic cholecystectomy(LC)in grassroots hospitals,and to improve the success rate and safety of treating complex gallbladder.Methods From May 2020 to Nov.2023,a total of 2862 LC cases were performed at Zhoukou Central Hospital.There were 2341 cases of conventional LC(CLC group)and 521 cases of difficult LC(DLC group).Within the DLC group,340 cases underwent laparoscopic subtotal cholecystectomy and 181 cases underwent laparoscopic total cholecystectomy.Results Compared with the CLC group,the DLC group had significant longer operation time[(120.6±20.5)min vs(30.2±15.8)min],more intraoperative blood loss[(90.5±10.2)mL vs(20.5±3.5)mL],longer postoperative hospitalization time[(13.2±1.5)d vs(3.0±0.7)d],and higher postoperative bile leakage rate[2.88%(15/521)vs 0.04%(1/2341)],with statistically significant difference(all P<0.05).However,there was no significant difference in hospitalization costs[(1.31±0.03)ten thousand yuan vs(1.28±0.03)ten thousand yuan]between DLC group and CLC group.No intraoperative biliary tract or portal vein injury occurred in this two groups.There were 15 cases of postoperative bile leakage in DLC group,among them,12 cases were cured after 2 weeks of drainage,and the remaining 3 cases were cured after nasobiliary drainage due to larger biliary fistula.Compared with the patients who underwent total cholecystectomy,patients who underwent subtotal cholecystectomy in the DLC group had shorter operation time[(106.7±14.4)min vs(134.5±22.9)min],less intraoperative blood loss[(77.2±10.5)mL vs(103.8±16.8)mL],shorter drainage tube indwelling time[(4.1±0.8)d vs(7.9±1.7)d],shorter postoperative hospitalization time[(11.4±1.5)d vs(15.0±0.7)d]and shorter gastrointestinal recovery time[(1.6±0.6)d vs(2.8±1.0)d],with statistically significant difference(all P<0.05).There was no related surgical complication during the 1-year follow-up.Conclusion For difficult LC,subtotal cholecystectomy has the advantages of smaller side effect

关 键 词：腹腔镜胆囊切除术 复杂胆囊 胆囊次全切除术 基层医院 

分 类 号：R657.4[医药卫生—外科学]