腹腔镜胆囊切除术中安全性关键术野技术应用的影响因素

Factors influencing the application of critical view of safety technology in laparoscopic cholecystectomy

目的评价安全性关键术野(CVS)在腹腔镜胆囊切除术(LC)中应用的影响因素。方法回顾性分析2022年1-12月武警安徽总队医院普外科收治的304例胆囊良性疾病患者手术视频资料,按照CVS实施标准将患者划分为CVS组(212例)和非CVS组(92例),比较两组患者手术操作时间、术中出血量、胆管损伤、术后胆漏、术后住院时间等差异,同时对CVS实施的影响因素进行logistic回归分析。结果两组手术操作时间[(38.52±5.66)mm vs.(45.82±6.63)mm]比较差异有统计学意义(P<0.05);CVS组患者胆漏发生率明显低于非CVS组(0%vs.2.17%)。对CVS技术实施的影响因素进行logistic回归分析,结果显示,中/重度胆囊炎、胆囊颈部结石嵌顿、胆囊壁增厚>5 mm、胆囊纤维化、胆管变异是影响LC实施CVS技术的独立危险因素。结论CVS技术应用有一定条件,临床应灵活选择手术策略。

Objective To evaluate the influencing factors of critical view of safety(CVS)in laparoscopic cholecystectomy(LC).Methods The surgical video data of 304 patients with benign gallbladder diseases admitted to the Department of Surgery of Anhui Provincial Crops Hospital of Chinese People’S Armed Police Force from January 2022 to December 2022 were retrospectively analyzed.According to the implementation criteria of CVS,the patients were divided into CVS group(212 patients),and non-CVS group(92 patients).The differences between the two groups in operation time,intraoperative bleeding,bile duct injury(BDI),postoperative biliary leakage,and postoperative hospital stay were compared.At the same time,the factors affecting the implementation of CVS were analyzed by logistic analysis.Results There was significant difference in the operation time between the two groups[(38.25±5.66)mm vs.(45.82±6.63)mm;P<0.05];the incidence of biliary leakage in CVS group was much lower than that in non-CVS group(0%vs 2.17%).Logistic regression analysis was carried out on the factors influencing the successful implementation of CVS technology in LC surgery.The results showed that moderate/severe cholecystitis,stone incarceration in the neck of gallbladder,thickening of gallbladder wall>5 mm,gallbladder fibrosis and bile duct variation were independent risk factors affecting the implementation of CVS technology in LC.Conclusions The application of CVS technology has certain conditions,and the surgical strategy should be selected flexibly in clinic.