腹腔镜胆囊切除术顺行切除与逆行切除的比较与体会

Laparoscopic Cholecystectomy Anterograde Resection and Retrograde Resection Comparison and Experience

目的探讨腹腔镜胆囊切除术中顺行与逆行的选择策略,以降低风险,提高临床疗效。方法对59例腹腔镜胆囊切除术(顺行切除36例,逆行切除23例)对比分析术式选择依据、术中出血量、手术时间、术后并发症、住院时间等。结果平均手术时间:顺行(10.5±5.2)min,逆行(12.2±7.3)min(P<0.01),术中出血量:顺行(11.0±0.7)mL,逆行(17.3±3.2)mL(P<0.01),平均住院时间:顺行(3.0±0.6)d,逆行(3.0±0.9)d(P>0.05)。结论胆囊三角解剖结构不清或发生较大变异的病例宜选用逆行切除法,二者的临床疗效相似,但选择合适的方法有助于降低切除难度,减少并发症。

Objective To study the laparoscopic cholecystectomy anterograde and retrograde choice strategy,in order to reduce risk and improve the clinical effect.Methods 59 cases of laparoscopic cholecystectomy（anterograde resection（36 cases） and retrograde resection of 23 cases） a comparative analysis of the choice of basis,surgical decompression of the amount of bleeding,operation time,postoperative complications,the length of time and so on.Results The mean operation time： anterograde 10.5±5.2min,retrograde 12.2±7.3min（P0.01）,during the operation,the amount of bleeding： anterograde 11.0±0.7mL,retrograde 17.3＋/-3.2mL（P0.01）,the average hospitalization time： anterograde 3.0±0.6days,retrograde 3.0±0.9days（P0.05）.Conclusion The gallbladder triangle anatomical structure is not clear or the occurrence of large variation of cases appropriate chooses retrograde nephrectomy,both the clinical curative effect of the similar,but choose the right method can help to reduce the difficulty of resection,reduce the complications.