改良隐瘢痕腹腔镜与单孔腹腔镜胆囊切除术对比研究

Comparison of modified umbilical laparoscopic operation and single-hole cholecystectomy

目的探讨改良经脐及白线隐瘢痕腹腔镜胆囊手术的临床疗效及应用价值。方法回顾性分析2011年6月至2013年5月江西省宜丰县人民医院收治的胆囊结石患者193例,随机分为二组,观察组行改良经脐及白线隐瘢痕腹腔镜胆囊手术,对照组行常规单孔法腹腔镜手术。对比分析二组患者手术时间、术后切口疼痛程度、术后切口满意程度及中转率。结果观察组比对照组手术时间短,差异有统计学意义(t=14.72,P<0.000 1)。观察组术后1 d切口疼痛程度明显轻于对照组(t=11.42,P<0.000 1);术后2 d切口疼痛程度差异无统计学意义(t=1.26,P=0.10)。术后患者切口满意程度差异无统计学意义(t=1.51,P=0.067);对照组有3例中转手术。二组均无胆管损伤、术后出血、胆漏等并发症发生。结论改良经脐及白线隐瘢痕腹腔镜胆囊手术安全、可行,不需要特殊器械,术后瘢痕不明显且隐蔽,手术难度不高,术后患者切口满意度高,是一种美观、安全的腹腔镜手术新途径,适合在基层医院推广。

Objective To investigate the effectiveness and value of the umbilical and white scar hidden laparoscopic operation. Methods A total of 193 patients with gallstone recruited from The People＇s Hospital of Yifeng County from June 2011 to May 2013 were retrospectively analyzed and randomly classified into two groups. The patients in the observation group were treated by umbilical and white scar hidden laparoscopic gallbladder operation. The patients in the control group were applied with traditional single-hole laporoscopic operation. The two groups of patients with operation time, pain after operation, postoperative incision satisfaction and transfer rate were compared. Results the operation time is shorter in the observation group with statistically significant difference （ t = 14. 72, P 〈 0. 000 1 ）. After one day, The degree of incision pain was more serious in the observation group than that of the control group （ t = 11.42, P 〈 0. 000 1 ）. There was no significant difference in the postoperative incision pain in the second day after operation （t = 1. 26, P = 0. 10）. No significant difference in the patients with postoperative incision satisfaction was found （t = 1.51 ,P =0.067 ）. There were 3 cases who were converted to operation. No bile duct injury , bleeding, bile leakage and other complications in the two groups were observed. Conclusions The modified umbilical and white scar hidden laparoscopic gallbladder operation is safe and feasible, which is a new way of laparoscopic operation and suitable for primary care.