腹腔镜下后三角入路联合钝性冷分离在腹腔镜胆囊切除术中的效果

Effect of laparoscopic posterior triangle approach combined with blunt cold separation in laparoscopic cholecystectomy

目的探讨腹腔镜下后三角入路联合钝性冷分离在腹腔镜胆囊切除术(LC)中的效果。方法回顾性分析2017年10月至2019年2月在我院接受LC治疗的168例患者的病历资料,按照不同手术入路方法将患者分为对照组(胆囊三角入路)与观察组(胆囊后三角入路联合钝性冷分离),各84例。比较两组患者的手术时间、术中出血量、胃肠功能恢复时间、住院时间、副损伤、并发症发生情况、中转开腹率、术前、术后3 d的炎性因子水平、肠黏膜屏障功能及术前、术后3个月的生活质量。结果观察组患者的手术时间、胃肠功能恢复时间、住院时间均短于对照组,术中出血量少于对照组(P<0.05)。观察组患者的副损伤发生率、并发症总发生率及中转开腹率均低于对照组(P<0.05)。术后3 d,两组患者的Cor、C-P、CRP、IL-6、D-乳酸水平均升高,但观察组低于对照组(P<0.05)。术后3个月,两组患者的生活质量均升高,观察组高于对照组(P<0.05)。结论后三角入路联合钝性冷分离在LC中可有效缩短手术时间和住院时间,减少术中出血量,降低副损伤、并发症发生率、中转开腹率,有利于减轻机体炎性应激反应,促进胃肠功能恢复,有利于患者生活质量的提高。

Objective To explore the effect of laparoscopic posterior triangler approach combined with blunt cold separation in laparoscopic cholecystectomy(LC).Methods From October 2017 to February 2019,the medical records of 168 patients who received LC treatment in our hospital were analyzed retrospectively.According to different surgical approaches,the patients were divided into control group(gallbladder triangle approach)and observation group(posterior triangle approach combined with blunt cold separation),with 84 cases in each group.The operation time,intraoperative bleeding volume,recovery time of gastrointestinal function,hospitalization time,side injury,complications,conversion rates of laparotomy,levels of inflammatory factors,intestinal mucosal barrier function before and at 3 days after operation and quality of life before and at 3 months after operation were compared between the two groups.Results The operation time,recovery time of gastrointestinal function and hospitalization time of patients in the observation group were shorter than those in the control group,and the intraoperative bleeding volume was less than that in the control group(P<0.05).The incidence of side injury,total incidence of complications and conversion rate of laparotomy in the observation group were lower than those in the control group(P<0.05).At 3 days after operation,the levels of Cor,C-P,CRP,IL-6 and D-lactate in the two groups increased,but those in the observation group were lower than the control group(P<0.05).At 3 months after operation,the quality of life scores in the two groups increased,and that in the observation group was higher than the control group(P<0.05).Conclusion Posterior triangle approach combined with blunt cold separation in LC can effectively shorten the operation time and hospitalization time,reduce the intraoperative bleeding volume,reduce the incidence of side injury,complications,conversion rate of laparotomy,reduce the inflammatory stress response of the body,promote the recovery of gastrointestinal function,and improve the quality of life of patients.