小切口胆囊切除术切口长度相关因素的临床研究

The clinical study on correlative factors of incisive length by minicholecystectomy

目的 :探讨小切口胆囊切除术 (MC)中可行而实用、便捷而直观的参数 ,供MC术前术中选择合适、安全切口长度之用。方法 :选择 5 9例胆囊良性病变病人为研究对象。术前测量腹围和肋弓角度 ,B超测量胆囊大小和壁厚度 ,右上腹肋缘下切口皮肤划痕面至Calot距离 (暂名Calot深度 )。术中测量切口长度 ,切口皮缘中点至Calot距离 (暂名Calot深度 )和皮下脂肪厚度 ,分别作相关分析处理。结果 :切口 6cm以内MC成功率为 81.36 % (48/ 5 9)。其余需延长切口至 6cm以上才能完成手术 ,占 18.6 4 % (11/ 5 9)。腹围与切口长度呈正相关 (r=0 .5 180 ,t=4 .5 791,P <0 .0 0 1) ,有直线回归关系 (b =0 .0 86 2 ,t=4 .5 74 5 ,P <0 .0 0 1)。Calot深度与切口长度呈正相关 (r=0 .32 2 9,t=2 .5 790 ,P <0 .0 2 ) ,有直线回归关系 (b =0 .2 4 74 ,t=2 .5 76 0 ,P <0 .0 5 )。结果表明 :腹围和Calot深度是决定切口长短的关键因素 ,其次为胆囊大小和胆囊壁厚度。皮下脂肪和肋弓角度与切口长度无相关性。结论 :术前选择腹围在 85cm以下 ,B超Calot深度不超过 10cm ,对胆囊纵径在 8cm以下和胆囊壁厚度小于 4mm的病人行MC较为理想 ,其可确保MC安全 ,提高手术成功率。

Objective:To investigate the feasible,practical,convenient and intuitive parameters for the selection of suitable and safe length of incision before minicholecystectomy(MC).Methods:Select 59 cases of benign disease of gallbladder for study target and measure abdominal encirclement and gallbladder including size morphology,wall thickness and distance from calot triangle to skinny incision under right costa(calot depth) before MC by B mode ultrasonography. Then measure incisive length,calot depth and fat thickness under skin and make respective analysis of correlation.Results:The success rate of MC with the incision of less than 6 cm is 81.36%(48/59) and the remainder,18.64%(11/59),can be made successfully with the prolonged incision of more than 6 cm. There is positive correlation between abdominal encirclement and incisive length (r=0.5180,t=4.5791,P<0.001),and linear correlation (b=0.0862,t=4.5745,P<0.001). There is positive correlation between the abdominal encirclement and the calot depth(r=0.3229,t=2.5790,P<0.02),and linear correlation(b=0.2474,t=2.5760,P<0.05). Abdominal encirclement and calot depth,and then the size and wall thickness of gallbladder,are the key factors to determine incisive length. There is no correlation between fat thickness under skin and rib bow angle and incisive length.Conclusion:It is ideal for MC to select abdominal encirclement of less than 85 cm,and calot depth of less than 6 cm,vertical track of less than 8 cm and gallbladder thickness of less than 4 mm,which can ensure safety and high success rate.