腹腔镜胆囊切除术中应用经侧方入路与顺行剥离术治疗胆囊结石的效果  

Effect of lateral approach and anterograde dissection in laparoscopic cholecystectomy in the treatment of gallstones

作　　者：邓海文 薛峰 汤枫 黄玉海 张彬 DENG Haiwen;XUE Feng;TANG Feng;HUANG Yuhai;ZHANG Bin(Department of General Surgery,the Third People's Hospital of Pingxiang City,Pingxiang,Jiangxi,337000,China)

机构地区：[1]萍乡市第三人民医院普外科,江西萍乡337000

出　　处：《当代医学》2024年第8期127-131,共5页Contemporary Medicine

摘　　要：目的分析腹腔镜胆囊切除术中应用经侧方入路与顺行剥离术治疗胆囊结石的效果。方法选取2019年1月至2022年5月于萍乡市第三人民医择期行腹腔镜胆囊切除术治疗的78例胆囊结石患者作为研究对象,按照随机数字表法分为研究组与对照组,各39例。研究组腹腔镜胆囊切除术中经侧方入路,对照组腹腔镜胆囊切除术中行顺行剥离手术,比较两组围手术期指标、并发症发生率及手术前后炎症指标、应激反应指标。结果两组手术时间、术中出血量比较差异无统计学意义;研究组术中胆囊剥离时间、术后离床时间均短于对照组,差异有统计学意义(P<0.05)。研究组并发症发生率低于对照组,差异有统计学意义(P<0.05)。术后72h,研究组降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平均低于对照组,差异有统计学意义(P<0.05)。术后72h,研究组WBC、空腹血糖(FPG)水平均低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜胆囊切除术中采用经侧方入路可缩短胆囊剥离时间,促进术后早期康复,改善患者炎症及应激反应,降低并发症发生风险,值得临床推广应用。Objective To analyze the effect of lateral approach and antegrade dissection in laparoscopic cholecystectomy in the treatment of gall-stones.Methods 78 patients with cholecystolithiasis who underwent laparoscopic cholecystectomy during the the Third People's Hospital of Pingx-iang City from January 2019 to May 2022 were selected as the study subjects,and they divided into the study group and the control group according to random number table method,with 39 cases in each group.The study group underwent lateral approach laparoscopic cholecystectomy,while the control group underwent anterograde dissection during laparoscopic cholecystectomy.Perioperative indexes,complication rate,inflammatory indexes and stress response indexes were compared between the two groups.Results There were no significant differences in operation time and intraopera-tive blood loss between the two groups;the time of gallbladder dissection during operation and the time of leaving bed after operation in the study group were shorter than those in the control group,the differences were statistically significant(P<0.05).The complication rate in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).At 72 h after operation,the levels of procalcitonin(PCT),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)in the study group were lower than those in the control group,and the differ-ences were statistically significant(P<0.05).At 72 h after operation,the levels of WBC and asting plasma glucose(FPG)in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion The use of lateral approach in laparo-scopic cholecystectomy can shorten the time of gallbladder dissection,promote early postoperative rehabilitation,improve inflammation and stress re-sponse,and reduce the risk of complications,and is worthy of clinical promotion and application.

关 键 词：胆囊结石 腹腔镜胆囊切除术 经侧方入路 顺行剥离 并发症 

分 类 号：R657.42[医药卫生—外科学]