摘要
目的比较不同Calot三角解剖入路在腹腔镜胆囊切除术(LC)中的应用效果。方法根据不同Calot三角解剖入路方式分组,在行LC术治疗胆囊结石伴慢性胆囊炎患者时,100例采用胆囊后三角解剖入路(观察组),另100例采用胆囊三角入路(对照组),采用免疫比浊法测定血清C反应蛋白(CRP),采用ELISA法测定血清白细胞介素-6(IL-6)、白介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)水平,采用视觉模拟评分(VAS)工具评估疼痛程度,比较两组手术指标及手术前后血清细胞因子水平变化。结果在手术中,发现观察组胆囊周围出现粘连53例,对照组50例;两组无胆囊粘连患者组间各手术指标、手术并发症和中转开腹发生率比较均无显著性差异(P>0.05);观察组粘连患者手术时间、术中出血量、术后肠功能恢复时间、住院时间和术后VAS评分分别为(29.4±4.3)min、(33.9±4.6)ml、(26.0±4.2)h、(6.0±1.0)d和(4.0±1.5)分,均显著少于或轻于对照组粘连患者【(59.1±5.5)min、(45.6±4.1)ml、(30.3±4.5)h、(8.4±1.0)d和(4.8±1.3)分,P<0.05】;观察组胆囊粘连患者无并发症和中转开腹者,而对照组胆囊粘连患者则分别为8.0%和8.0%(P<0.05);治疗后,观察组血清CRP、IL-6、IL-8和TNF-α水平均显著低于对照组(P<0.05)。结论经胆囊后三角解剖入路行LC术能明显减少胆囊粘连患者术中出血量,显著降低并发症和中转开腹发生率。在LC术中需密切观察胆囊粘连与否及其程度等情况,而给予合理的处理。
Objective To analyze the efficacy of different Calot triangle anatomical approaches duringlaparoscopic cholecystectomy （LC）in the treatment of patients with gallbladder stones with chronic cholecystitis.Methods 200 patients with gallbladder stones with chronic cholecystitis were divided into two groups accordingto different Calot triangle anatomical approaches during LC, and 100 patients received LC by posteriorgallbladder triangle anatomical approach （observation group） and another 100 by gallbladder triangle approach（control group） . The operation indexes were compared, and serum cytokines were detected by ELISA. Results Wefound 53 patients in observation group and 50 in control having adhesion around gallbladder during LC. Therewas no significant differences between the two groups without adhesion as respect to operational indexes,complications and the rates of conversion to laparotomy（P〉0.05）; The operation time, intraoperative bleeding, timefor intestinal function recovery after operation, hospital stay and postoperative visual analogue scale（VAS）score ofpain in patients with adhesion in the observation group were（29.4±4.3）min,（33.9±4.6）ml,（26.0±4.2）h,（6.0±1.0）d, and （4.0±1.5）, significantly shorter, lesser or lower than those in patients with adhesion in the control group[ （59.1±5.5）min,（45.6±4.1）ml,（30.3±4.5）h,（8.4±1.0）d, and （4.8±1.3）, P〈0.05]; There was not incidence ofcomplications or conversion to laparotomy in patients with adhesion around gallbladder in the observation group,while they were 8.0% and 8.0% in patients withadhesion around gallbladder in the control group（P〈0.05）; Serum levels of C reactive protein,interleukin-6, interleukin -8 and tumor necrosis factor afteroperation in the observation group were significantlylower than those in the control group （P〈0.05） . Conclusion Posterior gallbladder triangle anatomical approach cansignificantly reduce bleeding in patients with gallbladder adhesion, significantly decrease the incidence ofcomplications and the rate of conversion to open operation. In laparoscopic cholecystectomy, the gallbladderadhesion needs to be observed closely and dealt with properly.
作者
牛四明
NiuSiming(Department of General Surgery, Zhoukou Hospital of Traditional Chinese Medicine, Zhoukou 466000, HenanProvince, Chin)
出处
《实用肝脏病杂志》
CAS
2018年第3期447-450,共4页
Journal of Practical Hepatology
作者简介
牛四明,男,47岁,大学本科,副主任医师.研究方向：肝胆外科疾病诊疗.E-mail：rayh59629373@163.com
