两孔法腹腔镜胆囊切除术40例体会

Laparoscopic cholecystectomy by a two-hole method: report of 40 cases

目的：探讨两孔法腹腔镜胆囊切除术在临床上的应用。方法收集2011年3月至2012年3月接受腹腔镜胆囊切除术患者随访资料，回顾性分析两孔法40例患者，三孔法50例患者资料，对比两组患者的疗效。数据用SPSS20．0进行分析，两组手术时间、术后排气时间、住院时间、下床时间、采用t检验；术后疼痛情况、术后患者满意度、术后并发症采用卡方检验，且以P值小于0．05具有统计学意义。结果90例腹腔镜胆囊切除术患者均顺利完成手术且无并发症发生。两孔法手术时间（41±12．3） min比三孔法（48±15．88） min短，差异有统计学意义（t＝2．357， P＝0．036）。两孔法与三孔法术后肛门排气时间（1．2±0．22） d 比（1．9±0．17） d、术后首次下床活动时间（1．2±0．22） d 比（1．9±0．17） d、术后住院天数（3．8±0．85） d 比（5．1±0．71） d，均比三孔法有优势，两组比较差异均有统计学意义（P＜0．05）。术后疼痛评分为0分者两孔法组有22例（55．0％），三孔法组仅有13例（26．0％）；疼痛评分介于7～10分之间的患者两孔法组有4例（10．0％），三孔法组有8例（16．0％），两组比较差异均有统计学意义（u＝2．552， P＝0．010）。满意度评分两孔法组5分者有14例（35．0％），三孔法组有8例（16．0％），两组比较差异有统计学意义（u＝2．428， P＝0．015）。结论两孔法患者较三孔法患者疼痛明显减轻、术后满意度好，值得推广。

Objective To explore the clinical application of two-hole laparoscopic cholecystectomy . Methods Clinical data of patients who received laparoscopic cholecystectomy in our hospital from 2011.3 to 2012.3, including two-hole method used in 40 patients and three-hole method used in 50 patients, were analyzed retrospectively .Clinical outcome in the two groups were compared using Student’s test for operation time, duration of venting , hospital stay , and duration of off-bed.Postoperative pain , satisfaction of patients and complications were evaluated by the chi-square test.A P value 〈0.05 was considered statistically significant. Results The patients in the two groups received successful operation without complications.Operative time in the two-hole group was （41 ±12.3） min , which was shorter than （48 ± 15.88） min in the three-hole group （t=2.357, P=0.036）.Duration of venting was （1.2 ±0.22） d and （1.9 ±0.17） d, duration of off-bed was （1.2 ±0.22） d and （1.9 ±0.17） d, hospital stay was （3.8 ± 0.85） d and （5.1 ±0.71） d in the two-hole group and the three-hole group, with significant difference respectively（P 〈0.05）.There were 22 patients （55.0%） with value of 0 of VAS, while 13 cases （26.0%） in three-hole method group.There were 4 patients （10.0%） with a value of 7-10 of VAS in the two-hole group, but 8 patients （16.0%） in the three-hole group （u=2.552, P=0.010）.There were 14 patients （35.0%） with 5 points of satisfaction, whereas 8 patients （16.0%） in the three-hole group （u=2.428, P=0.015）. Conclusion Laparoscopic cholecystectomy using the two-hole method could alleviate the pain of patients with better satisfaction .