后三脚入路在三孔法腹腔镜胆囊切除术中的临床应用

Clinical Application of Posterior Three-leg Approach in Laparoscopic Cholecystectomy with Three-hole Approach

目的对比分析在腹腔镜胆囊切除术中使用三孔法后三角入路和四孔法前三角入路的临床疗效,为入路方式的合理选择提供科学的参考依据,提升患者的治疗效果。方法于该院2013年2月—2017年12月的接收的腹腔镜胆囊切除术患者中,随机选取144例患者作为研究对象,将随机双盲法作为分组依据,将所有患者分为对照组和治疗组各72例。其中,予以对照组患者四孔法前三角入路方法,治疗组患者实施三孔法后三角入路方法。观察两组患者的治疗效果、并发症情况、手术指标以及生活质量评分情况。结果对照组患者的治疗总有效率为69.44%,治疗组患者的治疗总有效率为97.22%(χ~2=6.03,P<0.05)。对照组患者的并发症发生率为20.83%,治疗组患者的并发症发生率为4.17%(χ~2=5.25,P<0.05),对照组的手术时间为(109.34±2.78)min,长于治疗组患者的手术时间为(56.33±1.17)min(t=20.06,P<0.05);对照组住院时间为(9.04±0.52)d,长于观察组(3.71±0.13)d(t=21.347,P<0.05);对照组术中出血量为(120.69±5.06)m L,高于观察组(47.84±3.98)mL(t=22.53,P<0.05);对照组术后疼痛时间为(37.24±1.53)h,长于观察组(16.07±1.02)h(t=23.07,P<0.05)。结论在行三孔法腹腔镜胆囊切除术的过程中,应采用三孔法后三角入路方式,实现对胆管损伤和腹腔感染等并发症的有效预防,降低术中出血量,缩短患者的术后康复时间,全面提升患者的生存质量,实现对患者痛苦程度的有效缓解。

Objective To compare and analyze the clinical efficacy of three-hole posterior triangulation approach and four-hole anterior triangulation approach in laparoscopic cholecystectomy to provide a scientific basis for the rational selection of approach and improve the treatment of patients. effect. Methods In the patients undergoing laparoscopic cholecystectomy from February 2013 to December 2017 in this hospital, 144 patients were randomly selected as the study subjects. The randomized double-blind method was used as a group basis and all patients were divided into controls. 72 patients in treatment group. Among them, the control group was given a four-hole method before the triangle approach, and the patients in the treatment group were subjected to the three-hole method and the triangular approach. The treatment effects, complications, surgical indexes, and quality of life scores of the two groups were observed. Results The total effective rate of the control group was 69.44%. The total effective rate of the treatment group was 97.22% （χ2=6.03, P〈0.05）. The complication rate was 20.83% in the control group, 4.17% in the treatment group （χ2=5.25, P〈0.05）, and the operation time in the control group was（109.34±2.78）min, which was longer than that in the treatment group. The operation time was （56.33±1.17）min （t=20.06, P〈0.05）; the hospital stay in the control group was （9.04±0.52）days, which was longer than the observation group （3.71±0.13）days（t=21.347, P〈0.05）. The intraoperative blood loss in the control group was （120.69±5.06）mL, which was higher than that of the observation group （47.84±3.98） mL（t=22.53, P〈0.05）. The postoperative pain duration in the control group was （37.24±1.53）h, which was longer than observation group （16.07±1.02）h （t=23.07, P〈0.05）. Conclusion In the process of three-hole laparoscopic cholecystectomy, three-hole posterior triangulation approach should be adopted to achieve effective prevention of complications such as bile duct injury and intra-abdominal infection, reduce intraoperative blood loss, and shorten the patient＇s recovery time after surgery, improving the patient＇s quality of life in an all-round way and achieving effective relief of the patient＇s pain.