经直肠纯自然腔道内镜手术保胆手术与外科开腹胆囊切除术及腹腔镜下胆囊切除术治疗胆囊结石或息肉的效果对比观察

Comparison of natural orifice transluminal endoscopic surgery,open cholecystectomy and laparoscopic cholecystectomy in the treatment of cholecystolithiasis and gallbladder polyps

目的比较自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)保胆手术与外科开腹胆囊切除术及腹腔镜下胆囊切除术治疗胆囊结石或息肉的效果。方法回顾性分析哈尔滨医科大学附属第二医院2014年12月至2016年12月34例经直肠纯NOTES保胆手术、33例经外科开腹胆囊切除术及37例经腹腔镜下胆囊切除术的胆囊结石或息肉病变患者的临床资料,通过对术中出血量、手术时间、手术费用、患者住院时间、是否出现腹胀、腹泻、切口疼痛及患者心理状况进行统计分析,评估各术式的优缺点及在临床中的应用价值。结果外科开腹组术中出血量(82.27±83.74)ml多于腹腔镜组(31.95±22.98)ml和NOTES组(45.35±34.52)ml,差异均有统计学意义(P<0.05),腹腔镜组与NOTES组出血量比较,差异无统计学意义(P>0.05);NOTES组手术时间(194.26±92.95)min长于腹腔镜组(46.76±23.23)min和外科开腹组(114.82±54.54)min,三组两两比较,差异均有统计学意义(P<0.05);外科开腹组手术费用(30 320.36±8 819.31)元明显高于腹腔镜组(23 406.11±27 703.96)元及NOTES组(27 058.47±8 670.16)元,差异均有统计学意义(P<0.05),腹腔镜组与NOTES组比较,差异无统计学意义(P>0.05);腹腔镜组住院时间(5.32±1.34)d短于外科开腹组(10.91±4.03)d及NOTES组(15.32±6.14)d,三组两两比较,差异有统计学意义(P<0.05)。采用两独立样本秩和检验及Bonferroni校正可知,腹腔镜组住院时间明显短于外科开腹组,外科开腹组短于NOTES组(P<0.05)。NOTES组腹胀情况明显优于外科开腹组和腹腔镜组,三组比较,差异有统计学意义(P<0.05);三组腹泻情况比较,差异无统计学意义(P>0.05);NOTES组患者切口疼痛程度明显低于外科开腹组和腹腔镜组,差异有统计学意义(P<0.05),NOTES组优于腹腔镜组(P<0.05),腹腔镜组优于外科开腹组(P<0.05);三组患者均未出现严重不良心理情况。结论三种术式均能治疗胆囊结石或息肉,且在不同方面各具优势。NOTES组因保留了胆囊,患者术后腹胀、切口疼痛等不良反应明显减少。

Objective To compare the effect of transrectal natural orifice transluminal endoscopic surgery（ NOTES）,open cholecystectomy and laparoscopic cholecystectomy in the treatment of cholecystolithiasis and gallbladder polyps. Methods The clinical data of 34 cases treated by NOTES,33 cases treated by open cholecystectomy and37 cases treated by laparoscopic cholecystectomy of cholecystolithiasis and gallbladder polyps in the Second Affiliated Hospital of Harbin Medical University from Dec. 2014 to Dec. 2016 were analyzed retrospectively. The clinical value was evaluated by statistically analyzing the blood loss,duration,fees of the operation,hospital days,abdominal distention and diarrhea,the pain of incision and the patients＇ mentation. Results The blood loss in open cholecystectomy group was more than that in laparoscopic cholecystectomy group and NOTES group,there was statistical difference among three groups（ P〈0. 05）. The duration was longer in NOTES group than that in laparoscopic cholecystectomy group and open cholecystectomy group,there was statistical difference among three groups（ P〈0. 05）. The operation fees were higher in the open cholecystectomy group than that in laparoscopic cholecystectomy group and NOTES group,there was statistical difference among three groups（ P〈0. 05）. The hospital days in laparoscopic cholecystectomy group were shorter than those in open cholecystectomy group and NOTES group,there was statistical difference among three groups（ P〈0. 05）.The abdominal distention in NOTES group was significantly less than that in open cholecystectomy group and laparoscopic cholecystectomy group,there was statistical difference among three groups（ P〈0. 05）. The diarrhea of these three groups had no statistical difference（ P〈0. 05）. The pain of incision in NOTES group was significantly less than that in laparoscopic cholecystectomy group and open cholecystectomy group,there was significant statistical difference among three groups（ P〈0. 05）. The degree of pain in NOTES group was less than that in laparoscopic cholecystectomy group（ P〈0. 05）. The degree of pain in laparoscopic cholecystectomy group was less than that in open cholecystectomy group,there was statistical difference between two groups（ P〈0. 05）. The patients＇ mentation of three groups had no statistical differences（ P〈0. 05）. Conclusion These three different operating methods can treat cholecystolithiasis and gallbladder polyps,and they have their own merits respectively.