单切口腹腔镜胆囊切除术治疗急性胆囊炎的可行性研究

Feasibility study of single incision laparoscopic cholecystectomy in the treatment of acute cholecystitis

目的探讨采用单切口腹腔镜胆囊切除术治疗急性胆囊炎的可行性,为急性胆囊炎的临床治疗提供循证医学证据。方法前瞻性收集2012年1月至2015年12月期间于笔者所在医院就诊的急性胆囊炎患者160例,随机均分为2组:单切口组行单切口腹腔镜胆囊切除术,三切口组行三切口腹腔镜胆囊切除术。比较2组患者的临床疗效。结果与三切口组相比,单切口组患者的手术时间略长,切口疼痛评分较低,主观满意度高(P<0.05),但2组患者的术中出血量、卧床时间、肛门排气时间、肠蠕动恢复时间、住院时间、各并发症发生率(包括腹腔感染、胆管损伤、胆瘘及切口感染),以及术后的T细胞亚群比例(包括CD3、CD4和CD8 T细胞)、免疫球蛋白水平(包括IgA、IgG和IgM)及C反应蛋白(CRP)水平比较差异均无统计学意义(P>0.05)。结论与三切口腹腔镜胆囊切除术比较,单切口腹腔镜胆囊切除术的疗效相当,但该手术的难度大,适应证选择应谨慎,更适合应用于择期行胆囊切除手术的患者。

Objective To explore the feasibility of single incision laparoscopic cholecystectomy in the treatment of acute cholecystitis, and to provide evidence based medicine for clinical treatment. Methods A total of 160 cases of acute cholecystitis who received treatment in our hospital from Jan. 2012 to Dec. 2015 were randomly divided into single incision group （n=80, received single incision laparoscopic cholecystectomy） and three incisions group （n=80, received three incisions laparoscopic cholecystectomy）. The clinical and laboratory indexes were compared between the 2 groups. Results Compared with the three incisions group, there were statistically significant differences in the operation time, incision pain score, and subjective satisfaction, which were better in single incision group （P〈0.05）. But there was no significant difference in the blood loss, bed time, anal exhaust time, recovery time of intestinal peristalsis, hospitalization time, incidence of complication （including abdominal infection, bile duct injury, biliary fistula, and incision infection）, ratios ofT cell subsets （including CD3, CD4, and CD8 T cell）, levels of immunoglobulin （including IgA, IgG, and IgM）, and level of C reactive protein （P〉0.05）. Conclusions The effectiveness of single incision laparoscopic cholecystectomy is as good as three incisions laparoscopic cholecystectomy, but this single incision laparoscopic surgery is difficult, and its indications should be cautious. Single incision laparoscopic cholecystectomy is more suitable for patients undergoing elective cholecystectomy.