腹腔镜与开腹手术治疗慢性萎缩性胆囊炎的比较

The Comparison of Laparoscopic Surgery and Laparotomy in the Treatment of Chronic Atrophic Cholecystitis

目的 探讨腹腔镜治疗慢性萎缩性胆囊炎的安全性和可行性.方法 回顾性分析浙江省人民医院2008年3月~2013年3月手术的慢性萎缩性胆囊炎的临床资料,由病人选择手术方式,腹腔镜组159例（三孔法）,开腹组108例,比较2组手术时间、术中出血量、止痛药使用率、切口液化及感染率和肠粘连发生率.结果 156例完成腹腔镜手术（包括胆囊大部切除1例）,3例中转开腹（1例胆囊三角粘连呈胼胝样分离时大量渗血,2例分离Calot三角困难）,术后无胆漏和肠梗阻等并发症;开腹组胆囊切除术105例,胆囊大部切除术3例,术后并发胆漏2例,胆总管结石2例,肠梗阻5例.与开腹组相比,腹腔镜组手术时间短[（51.4±7.8）min vs.（70.6±5.0） min,t=-22.754,P=0.000],术中出血少[（23.3±3.4） ml vs.（35.3±8.3） ml,t=-16.300,P=0.000],止痛药使用率低[17.0% （27/159） vs.47.2% （51/108）,χ2=28.443,P=0.000],切口液化及感染率低[1.3% （2/159） vs.6.5% （7/108）,χ2=3.903,P=0.048],粘连性肠梗阻发生率低[0%（0/159） vs.4.6% （5/108）,P=0.010].结论 在细致操作及熟练的腹腔镜技术前提下,认真遵循相关手术原则,腹腔镜手术治疗萎缩性胆囊炎是安全、可行的.

Objective To investigate the safety and feasibility of laparoscopic cholecystectomy （LC） for chronic atrophic cholecystitis. Methods We retrospectively analyzed 267 cases of chronic atrophic cholecystitis undergoing surgery in Zhejiang Provincial People＇s Hospital from March 2008 to March 2013. Patients were allocated to the laparoscopic surgery group and the laparotomy group according to their wishes. Totally 159 patients were included in LC group （3-port approach） and 108 in laparotomy group. The operation time, blood loss, analgesic usage, incision liquefaction, infection rate and the rate of adhesive ileus were compared between the two groups. Results A total of 156 patients underwent laparoscopic surgery successfully （including subtotal cholecystectomy in 1 case）, and 3 patients were converted to laparotomy due to large amount of exudation when gallbladder triangle adhesion was separated （ 1 case） and difficulty in separation of Calot triangle （2 cases）. No postoperative bile leakage, intestinal obstruction or other complications occurred. In laparotomy group of 105 cases, 3 patients underwent subtotal cholecystectomy. Postoperative bile leakage was observed in 2 cases, choledocholithiasis in 2 and intestinal obstruction in 5 cases. Compared with laparotomy group, the LC group had shorter operation time [ （51.4± 7.8 ） min vs. （70.6 ± 5.0） min, t = - 22. 754, P = 0. 000 ], lessbloodloss [（23.3±3.4） mlvs. （35.3 ±8.3） ml, t= -16.300, P=0.000], lower rate of analgesic usage [17.0% （27/ 159） vs. 47.2% （51/108）, X2 = 28. 443, P = 0. 0001, lower incision liquefaction and infection rate [ 1.3% （2/159） vs. 6.5% （7/108） ,X2 =3. 903, P = 0. 048] and lower intestinal obstruction rate [0% （0/159） vs. 4. 6% （5/108）, P = 0. 010]. Conclusion LC is a safe and feasible procedure for the treatment of chronic atrophic cholecystitis.