选择性胆道造影在急诊腹腔镜胆囊切除术中的应用效果

Application effect of selective cholangiography in emergency laparoscopic cholecystectomy

目的探讨选择性胆道造影(LOC)在急诊腹腔镜胆囊切除术中的临床效果及安全性。方法选择2013年4月~2017年4月我院急诊科收治的胆囊炎急性发作患者92例作为研究对象,按照手术方式的不同分为观察组和对照组,各46例。两组患者均给予腹腔镜胆囊切除术治疗,观察组在腹腔镜胆囊切除术中进行选择性行胆道造影。比较两组患者围术期的相关指标(手术时间、中转开腹率、术中出血量及住院时间),术中及术后并发症发生情况(胆道损伤、切口感染、胆总管残余结石、胆道感染、腹腔感染及术后综合征)。结果两组患者的手术时间、住院时间、切口感染、胆道感染及腹腔感染发生率比较,差异无统计学意义(P>0.05)。观察组患者的中转开腹率、胆道损伤率、胆总管残余结石率及术后综合征发生率明显低于对照组,术中出血量明显少于对照组,差异均有统计学意义(P<0.05)。结论选择性胆道造影在急诊腹腔镜胆囊切除术中可有效发现胆囊三角变异,如副右肝管,胆囊管汇入变异等,可有效避免医源性胆道损伤的发生,降低中转开腹率和术后并发症发生率、残余结石发生率,从而提高手术质量促进患者康复,临床疗效良好,安全性高。值得在急诊腹腔镜胆囊切除术中尤其在基层医院中推广应用。

Objective To investigate the clinical effect and safety of selective cholangiography （LOC） in emergency laparoscopic cholecystectomy.nethods Ninety-two patients with acute cholecystitis admitted into our emergency department of our hospital from April 2013 to April 2017 were selected as the study subjects,and they were divided into the observation group and control group according to the different surgical methods.Each group had 46 patients.Patients in the two groups were given laparoscopic cholecystectomy,in the observation group,LOC was given in laparoscopic cholecystectomy.Perioperative related indicators （operation time,the rate of transferring to laparotomy,intraoperative blood loss and hospital stay）,postoperative complications （biliary tract injury,incision infection,residual stones in common bile duct, biliary tract infections,abdominal infection and postoperative syndrome） were compared in patients between the two groups.Results There was no significant difference in operative time,hospital stay,and the incidence of incision infec- tion,biliary tract infection and abdominal infection between the two groups （P〉O.05）.In the observation group,the rate of transferring to laparotomy,the rate of biliary tract injury,residual stones in common bile duct and the incidence of postoperative syndrome were significantly lower than those of the control group,and intraoperative blood loss in the observation group was significantly fewer than that of the control group （P〈0.05）.Conclusion LOC in emergency laparoscopic cholecystectomy can effectively find triangular gallbladder trigonometry variation,such as the deputy right hepatic duct, variation of cystic duct inflow and so on,and it can effectively avoid the occurrence of iatrogenic biliary tract injury,reduce the rate of transferring to laparotomy and postoperative complications,reduce the incidence of residual stones to improve the quality of surgery to promote the rehabilitation of patients,clinical curative efficacy is good and the safety is high.h is worth promoting and applying in emergency laparoscopic cholecystectomy,especially in primary hospitals in clinic.