自制肝悬吊拉钩与三叶牵开器在腹腔镜胃旁路手术中的应用效果比较

Comparison of application effects of the self-made liver suspension retractor and trefoil retractor in laparoscopic gastric bypass surgery

目的:探讨自制肝悬吊拉钩与三叶牵开器在腹腔镜胃旁路手术中的应用效果。方法:选择2014年10月至2017年9月腹腔镜胃旁路手术患者60例,按手术日期先后顺序分为观察组(肝悬吊拉钩组)和对照组(三叶牵开器组)各30例,观察组采用自制肝悬吊拉钩完成肝下显露;对照组采用三叶牵开器完成。比较两组完成手术的时间、肝包膜血肿发生情况、所需手术人员以及医护人员对肝下显露的满意度。结果:观察组手术时间平均(134.67±9.96)min,对照组平均(148.80±7.55)min(T=6.192,P=0.0000);观察组无发生肝包膜血肿,对照组发生6例(χ~2=4.629,P=0.0314);观察组采用4孔操作法,手术人员较对照组少(T=8.240,P=0.0000);观察组肝下显露效果优于对照组,医护人员满意度高(T=16.718,P=0.0000)、(T=18.103,P=0.0000)。结论:在腹腔镜胃旁路手术中使用自制肝悬吊钩可以更好地显露手术视野,有效地缩短手术时间,提高手术成功率,节约人力资源,值得推广应用。

Objective: To explore the application effects of self-made liver suspension retractor and trefoil retractor in laparoscopic gastric bypass surgery. Methods: A total of 60 cases with laparoscopic gastric bypass surgery in XiaolanPeople'S Hospital of Guangdong city of Zhongshan from October 2014 to September2017 were chosen.They were divided into the observation group(liver hanging hook group)and the control group(trefoil retractor group )according to the date of surgery(30cases in each group). The patients in the observation group completed the subhepatic exposure with self-made liver suspension;the patients in the control group completed it with the trefoil retractor. The time of operation,the incidences of hepatic capsular hematoma,the required surgical personnel and the satisfactions ofsubhepatic exposure were compared between the two groups. Results: The time of operation was(134.67±9.96)min in the observation group and(148.80±7.55)min in the control group( t =6.192, P =0.0000).There were no liver capsular hematoma in the observation group while 6 cases in the control group(χ 2=4.629, P =0.0314).The observation group used 4 holes operation method, and operation personnel was less than that of the control group( t =8.240, P =0.0000);The liver exposure in the observation group was better than that in the control group and satisfaction of the medical staff was higher( t =16.718, P =0.0000)、( t =18.103, P =0.0000). Conclusion: The self-made liver suspension retractor in laparoscopic gastric bypass surgery can better reveal the operative field and the operation time got significantly shorter. It has improved the success rate of operation and saved human resources, so it's worthy of popularization and application.