超声刀与电凝钩在急诊腹腔镜胆囊切除术中的应用

Clinical Control Study on Application of Ultrasound Knife and Electric Coagulation Hook in Emergency Laparoscopic Cholecystectomy

目的比较超声刀与电凝钩在急诊腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的应用效果。方法回顾性分析2014年1月~2017年1月我科行急诊腹腔镜胆囊切除术的92例患者临床资料,其中49例术中采用超声刀(超刀组),43例使用电凝钩(电凝钩组),比较两组术中、术后各项指标。结果 92例患者均行急诊腹腔镜胆囊切除术,电凝钩组有4例中转开腹,其中2例为术中活动性出血,遂开腹确切止血,2例为电凝钩致胆总管部分损伤,开腹缝合放置T管。7例术后出现右上腹疼痛、发热(超声组4例,电凝钩组3例),延长引流管置管时间,加强抗感染好转。术后均未出现胆瘘。超声刀组手术操作时间、术中出血量、术后24 h引流量、引流持续时间、住院时间、中转开腹率均低于电凝钩组,差异有统计学意义(P<0.05);而两组术中胆道损伤率、术后腹腔积液感染率比较,差异均无统计学意义(P>0.05)。结论在急诊腹腔镜胆囊切除手术中,超声刀具有组织切割准确、周围组织损伤小、止血效果佳、出血少、术中操作时间短等优点;且术中操作视野清晰,解剖结构清楚,能够降低胆道损伤及中转开腹率,具有较好的临床应用效果。

Objective To compare the clinical application effects between ultrasound knife and electric coagulation hook in emergency laparoscopic cholecystectomy（LC）. Methods The clinical data of 92 cases received emergency LC were analyzed retrospectively. During the LC,ultrasound knife was applied in 49 patients as ultrasonic knife group,and electric coagulation hook was used in 43 patients as electric coagulation hook group. The intra-and post-operative indicators were compared between the two groups. Results All 92 cases underwent emergency LC,but 4 cases of electric coagulation hook group conversed to open surgery due to intra-operative active bleeding（2 cases） and partial common bile duct injury（2 cases）. Postoperative seroperitoneum infection was found in 4 cases of ultrasonic knife group and 3 cases of electric coagulation hook group,and was improved by anti-infection and prolonging drainage time. There was no biliary fistula in both groups.The operation time,intra-operative blood loss,drainage volume within 24 hours,drainage duration,hospital stays and transference rate in the ultrasonic knife group was lower than those in the electric coagulation hook group,and the differences were statistically between two groups（P 0. 05）. But there was no statistical difference in intraoperative bile duct injury and postoperative seroperitoneum infection rate between two groups（P0.05）. Conclusions The application of ultrasound knife has advantages of precise cutting,less tissue damage,ideal hemostatic effect,less bleeding,and short operating time in emergency LC. And it can achieve good clinical effects by clear operative visual fields,and anatomic structure and reducing the rate of biliary injury and transfer laparotomy.