两孔法与三孔法腹腔镜胆囊切除术的临床比较研究

Comparative Study of Two-Port and Three-Port Laparoscopic Cholecystectomy

目的比较两孔法和三孔法腹腔镜胆囊切除术的方法和效果.方法同期(2008年12月至2011年1月)102例患者,手术由同一有丰富腹腔镜操作技术的医师进行腹腔镜胆囊切除术,随机分为两孔法腹腔镜切除术组(50例)或三孔法腹腔镜胆囊切除组(52例),比较手术时间、术中失血、术后疼痛、术后住院天数、术后并发症和患者对术后切口疤痕的满意度.结果两孔法组2例患者因胆囊炎症及粘连严重而改为三孔法并顺利的完成手术.无中转开腹手术,比较两组病例,两孔法组的病例在平均手术时间(34.45±6.56)min短于三孔法(48.8±13.5)min,有统计学意义(P<0.05);在术后疼痛及术后患者对疤痕的满意度上两孔法组较三孔法组有明显的优势,具有统计学意义(P<0.05);而在术中失血,术后住院天数,术后并发症上两组差异无统计学意义(P>0.05).结论两孔法腹腔镜胆囊切除术是安全和可行的,其优势在于能够明显减轻术后疼痛时间并增加患者对手术的满意度.

Objective To compare and analyse the effects of two-port laparoscopic cholecystectomy and three-port laparoscopic cholecystectomy. Methods 102 patients who underwent laparoscopic cholecystectomy in Yui People＇s Hospital from Dec. 2008 to Jan. 2011 were randomly selected to receive either the two-port or the three -port technique. All patients were blinded to the type of operation they underwent. The length of the operation, bleeding amount, postoperative pain, postoperative complication, postoperative stay, and satisfaction of the patients score on scars were compared between two groups. Results In the two-port group, two cases had to be shifted to three-port LC due to severe adhesion. LC was successfully performed in all of the cases without conversion to laparotomy. In two-port group, the operative time was shorter than that of three port group （34.45 ＋ 6.56） min vs （48.8 _＋ 13.5） min, and there was a statistically signifidant difference （ P 〈0.05）. Postoperative pain and postoperative satisfaction was significantly different （ P 〈 0.05）. Other parameters including bleeding amount, hospital stay and postoperative complication were similar between the two groups. Conclusion Two-port laparoscopic cholecystectomy is safe and feasible with a higher patient satisfaction score and lighter postoperative pain than the conventional three -port laparoscopic cholecystectomy.