“三线”导向标记在腹腔镜下解剖困难型胆囊三角的临床应用价值探讨

Clinical Application Value of “Three-line” Guided Marker in Laparoscopic Anatomic Difficult Gallbladder Triangle

目的:探讨"三线"导向标记在腹腔镜下解剖困难型胆囊三角的临床应用价值。方法:对笔者所在医院2014年1月-2018年12月解剖困难型胆囊三角腹腔镜手术的患者58例进行回顾研究,根据患者术中胆囊三角的不同辨别方法分为观察组和对照组,观察组使用"三线"导向标记法,共39例,对照组采用常规的辨别方法,共19例,比较两组患者手术相关指标及术后并发症发生情况。结果:观察组患者手术时间和术中出血量均低于对照组,差异有统计学意义(P<0.05),两组患者肛门排气时间、术后下床活动时间及住院时间比较差异无统计学意义(P>0.05),观察组胆管损伤、血管损伤、迷走胆漏及术中转开腹发生率明显低于对照组,差异有统计学意义(P<0.05),两组患者术后出血的发生率差异无统计学意义(P>0.05)。结论:"三线"导向标记在腹腔镜下解剖困难型胆囊三角中具有重要的临床应用价值,能够缩短手术时间,减少胆管和血管误伤。

Objective:To explore the clinical application value of "three-line" guided marker in laparoscopic anatomic difficult gallbladder triangle.Method:A retrospective study was conducted on 58 patients with anatomically difficult gallbladder triangle undergoing laparoscopic cholecystectomy in our hospital from January 2014 to December 2018.The patients were divided into observation group and control group according to the different identification methods of gallbladder triangle during operation.The observation group used "three-line" guiding marker method,totaling 39 cases.The control group used conventional identification method.A total of 19 patients were enrolled in control group.The operative indexes and complications were compared between the two groups.Result:The operation time and intraoperative bleeding volume of the patients in the observation group were lower than those in the control group,and there were statistical differences(P<0.05).There were no significant differences in the time of anal exhaust,the time of getting out of bed after operation and the time of hospitalization between the two groups(P>0.05).The incidence of bile duct injury,vascular injury,vagal biliary leakageand conversion to laparotomy in the observation group was significantly lower than those in the control group,there was statistical difference(P<0.05).There was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05).Conclusion:The "three-line" guided marker has important clinical application value in laparoscopic anatomic difficult gallbladder triangle,which can shorten the operation time and reduce bile duct and vascular injury.