“一勾到底法”在腹腔镜胆囊切除术中预防并发症的应用体会(附173771例报告)

Application of "one dissector throughout whole operation" in laparoscopic cholecystectomy for prevention of complications:with a report of 173771 cases

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中应用电剥离钩"一勾到底法"的应用价值。方法:回顾分析1992年2月至2012年2月为173 771例患者行LC的临床资料,其中133 606例术中采用以电剥离钩为主的"一勾到底法"(观察组),应用"勾、打、压、推、撕、割、挑"操作技巧。同期为40 165例患者行常规LC(对照组),观察"一勾到底法"在减少手术并发症、缩短手术时间等方面的效果。结果:观察组36例(0.0269%)发生手术并发症,175例(0.131%)中转开腹,无一例死亡;胆囊分离切除时间一般为5 min,术后住院3～5 d。对照组60例(0.149%)发生并发症,431例(1.073%)中转开腹,3例死亡。两组患者并发症发生率、中转开腹率差异有统计学意义(P<0.01)。结论:LC术中应用"一勾到底法"可明显减少手术并发症,缩短手术时间、麻醉时间,减少出血量,减轻患者痛苦,术后康复快,在胆囊切除与胆道外科领域充分发挥了微创手术的优势,值得推广。

Objective：To research the application value of ＂one dissector throughout whole operation＂ in laparoscopic chole- eystectomy （LC）. Methods：The clinical data of 173 771 patients who underwent LC from Feb. 1992 to Feb. 2012 were retrospectively analyzed. 133 606 patients （observation group） were treated with ＂one dissector throughout whole operation＂, one electronic dissecting hook was the major apparatus and its operative skills included hooking, hitting, pressing, pushing, tearing, severing and stirring. At the same time 40 165 patients were treated with routine LC （ control group）. Their complications, time of operation, anesthesia and so on were observed. Results ： In observation group ,36 cases of complications were found （0. 0269% ） , 175 cases were converted to open sur- gery （0.131% ） , and no one died. Time of gallbladder removal was about 5 rain, postoperative hospital stay was 3-5 d. In control group, 60 cases of complications occurred （0. 149% ） ,431 cases were converted to open operation （ 1. 073% ）, and 3 cases died. Complica- tions and rate of converting to open choleeystectomy were significantly lower in observation group than those in control group （ P 〈0.01 ）. Conclusions： ＂One dissector throughout whole operation＂ in LC can significantly decrease incidence of complications,shorten time of operation and anesthesia,reduce hemorrhage, relieve pain of patients,make patients recover rapidly. Its advantage of mini-inva- sive operation is obvious in cholecystectomy and biliary surgery, this technique is worth popularization.