经皮纹不损伤腹直肌小切口在微创胆囊切除术中的应用

目的探讨经皮纹不损伤腹直肌小切口在胆囊切除术中的应用价值以及患者术后的生存质量。方法回顾性分析采用经皮纹不损伤腹直肌小切口行胆囊切除术46例（观察组），并与行传统腹直肌切口胆囊切除术35例（对照组）患者的临床资料、生存质量（评分）对比分析。结果手术时间、术中出血量、术后肠功能恢复时间、术后下床活动时问及术后住院时间观察组均优于对照组（P〈0．05）；GLQI总分，术后2周两组患者均有下降，观察组下降幅度不大（P〉0．05），对照组下降明显（P〈0．05），术后1个月观察组显著高于术前水平（P〈0．05），对照组与术前相似（P〉0．05），术后6个月两组均显著高于术前水平（P〈0．05），观察组上升更快、更明显（P〈0．05）；应用抗生素，观察组（3．01±0．22）d，明显短于对照组的（5．14±0．24）d；术后并发症发生率，观察组4．35％，明显低于对照组的14．29％（P〈0．05）。结论经皮纹不损伤腹直肌小切口手术创伤轻、恢复快、住院时间短、生存质量改善快及并发症少，是一种比较理想的胆囊切除手术方法。

Objective To investigate the technique of abdominis incision cholecystectomy without damaging the rectus in the value and quality of life of patients. Methods Retrospective analysis of the use of technique of small incision without damaging the rectus abdominis incision in 46 cases （observation group）, 35 regular traditional rectus abdominis incision cholecysteetomy （control group） clinical data, quality of life score were compared. Result The patients in the operative time, blood loss, postoperative intestinal function recovery time, postoperative ambulation time and hospital stay were less than the control group（ P 〈 0. 05 ）. GLQI score oft two groups of patients after 2 weeks decreased, but the decline in the observation group were not obvious （P 〉 0. 05 ）, while the control group GLQI score decreased significantly （ P 〈 0. 05 ） ; observed group of patients after 1 month GLQI total score was significantly higher than preoperative levels （ P 〈 0. 05 ）, while the control group patients after 1 month GLQI similar to the preoperative score （P 〉 O. 05） ; GLQI total score were significantlY higher than preoperative levels （P 〈 0. 05 ）, but the observation group increased faster and more pronounced （P 〈0. 05）. observation group were treated with antibiotics, 3.01 ± 0. 22d, significantly shorter than the control group, 5.14 ± 0. 24d （P 〈 0. 05 ） ; in the observation group, the postoperative complication rate was 4. 35% , significantly lower than the control group, 14. 29% （ P 〈 0. 05 ）. Conclusion For the technique of abdominis incision cholecystectomy without damaging the rectus, the surgical incision is small, it also has light trauma, faster recovery, shorter hospital stay, improved quality of life faster and fewer complications, thus is an ideal surgical method and worthy of clinical application.