吸引器解剖胆囊三角在急性胆囊炎行腹腔镜胆囊切除术中的应用

Dissection of Calot's Triangle by Suction Apparatus in Laparoscopic Cholecystectomy for Acute Cholecystitis

目的探讨急性结石性胆囊炎行腹腔镜胆囊切除术中采用普通吸引器钝性解剖胆囊三角的安全性及可行性。方法 2013年1月~2017年1月我院采用腹腔镜胆囊切除术治疗急性结石性胆囊炎患者408例,根据胆囊三角解剖使用器械的不同分为超声刀解剖组(UK组,n=200)及吸引器钝性解剖组(SA组,n=208)。比较分析两组患者临床资料。结果两组出血量、中转开腹率、腹腔引流率以及术后住院时间、腹腔引流时间、胆总管继发结石及腹腔残余感染发生率比较,差异均无统计学意义(P>0.05)。但UK组胆囊三角解剖时间长于SA组,胆管损伤率高于SA组,差异均有统计学意义(P<0.05)。两组均无不可控制的大出血,无气体栓塞、穿刺副损伤发生,中转开腹的3例患者均为胆囊三角区解剖困难。UK组及SA组分别有10例(5.00%)及2例(0.96%)患者出现胆汁漏(均为A级),组间比较有统计学差异(P<0.05)。两组患者术后均无严重并发症发生,无死亡病例,无非计划再次手术病例。所有病人均门诊随访,平均随访时间(28.74±11.59)个月,未见胆道狭窄,无腹痛、发热、黄疸等临床症状。结论急性结石性胆囊炎行腹腔镜胆囊切除术,术中采用吸引器解剖胆囊三角,不增加出血量,有利于缩短胆囊三角解剖时间,降低胆管损伤及胆汁漏发生率,安全可靠,值得临床推广应用。

Objective To discuss the safety and feasibility of using aspirator to dissect passively the Calot＇s triangle in laparoscopic cholecystectomy （LC） for acute calculous cholecystitis. Methods A total of 408 patients with acute calculous cholecystitis underwent LC from January 2013 to January 2017 were divided into ultrasound knife dissection group （UK group, n=200） and the blunt suction apparatus dissection group （SA group, n=208） according to the dissection technique of Calot＇s triangle anatomy of the gallbladder. The clinical curative effects were compared between the two groups. Results There was no statistical difference in bleeding loss, conversion rate to open surgery, abdominal drainage rate, the post-operative hospital stays, the abdominal drainage duration, the rate of secondary stones of the common bile duct and the residual infection rate of the abdominal cavity between the two groups （ P 〉0.05）. Compare to the SA group, the dissection time of gallbladder triangle was longer and the injury rate of bile duct was higher in UK group（ P 〈0.05）, and the differences were statistically （ P 〈0.05）. No uncontrollable hemorrhea, gas embolism and puncture injuries were found in all cases. There was bile leakage in 10 cases （5.00%） and 2 cases （0.96%） in UK group and SA group respectively, and the difference was statistically （ P 〈0.05）. No serious complications, deaths and unplanned reoperation occurred in both groups. All patients were followed up for an average period of （28.74±11.59） months. No biliary strictures, abdominal pain, fever and jaundice was found. Conclusions The dissection of Calot＇s triangle by suction apparatus is safe and reliable, and it does not increase the amount of bleeding, and is beneficial to shorten the operation time of dissection of Calot＇s triangle and reduce the incidence of bile duct injury and biliary leakage in LC for acute calculous cholecystitis. It is worthy of clinical application.