复杂胆囊患者行腹腔镜下逆行和次全胆囊切除术效果比较

Comparasion of fundus-first laparoscopic cholecystectomy and subtotal laparoscopic cholecystectomy in complicated cholecystolithiasis cases.

目的比较腹腔镜下逆行和次全胆囊切除对复杂胆囊病例的治疗效果。方法回顾性分析2008年至2009年我院对39例复杂胆囊病例实施腹腔镜逆行切除术（21例）和腹腔镜次全胆囊切除术（18例）的治疗效果。结果腹腔镜次全胆囊切除术手术时间[（88．89±18．11）min]相对短于腹腔镜逆行胆囊切除术[（109．52±21．79）min]，差异有统计学意义（P〈0．05）；前者术中出血量[（82．78±44．96）ml]和所需补液量[（847．22±169．32）m1]也少于后者[（116．67±53．23）ml和（964．29±147．60）ml]，差异有统计学意义（P均〈0．05）；患者术后恢复平稳，术后住院时间与腹腔镜逆行胆囊切除术无明显差异[（5．56±1．20）d与（5．29±1．38）d]，P〉0．05。结论对于复杂胆囊病例，合理实施腹腔镜胆囊次全切除术有助于简化手术操作，缩短手术时间，提高手术操作的安全性，而手术效果与腹腔镜逆行胆囊切除术无明显差异。

Objective To compare the effects of fundus-first laparoscopic cholecystectomy and laparoscopic subtotal cholecystectomy in complicated cholecystolithiasis cases. Methods The effects of fundus-first laparoscopic cholecystectomy （ n = 21 ） and laparoscopic subtotal cholecystectomy （ n = 18） in the 39 cases of complicated ehole- cystolithiasis from our hospital within 2 years were analyzed retrospectively. Results The operation time in subtotal laparoscopic cholecystectomy group was shorter than in fundus-first laparoscopic cholecystectomy group （88.89 ± 18.11 ） rain vs. （ 109.52 ± 21.79 ） min, P 〈 0. 05 ）. Less blood lose （ 82.78 ± 44.96） ml and fluid replacement （847.22 ±169.32） ml during the operation were observed in the former group than those in the later group （ 116.67 ± 53.23） ml and （964.29 ± 147.60） ml, respectively, P 〈0. 05 ）. However, the patients＇ postoperative recovery time and the duration of postoperative hospital staying were similar in the two groups （5.56±1.20） days vs. （5.29 ± 1.58） days, P 〉 0. 05 ）. Conclusions Proper use of subtotal laparoscopic cholecystectomy in complicated cholecystolithiasis cases can simplify the operation and obligate the operation time, which will increase the safety of the operation with the outcome similar to fundus-first laparoscopic cholecystectomy.