腹壁穿刺拉钩三孔法辅助腹腔镜胆囊切除术治疗肝胆外科胆囊疾病患者的临床疗效观察

Study on the effect of abdominal wall puncture and three-hole method assisted by laparoscopic cholecystectomy for patients with cholecystectomy in hepatobiliary surgery

目的观察腹腔镜胆囊切除术辅以腹壁穿刺拉钩三孔法治疗肝胆外科胆囊相关疾病的临床疗效。方法回顾性选取2018年1月至2020年1月期间淮南东方医院集团总医院肝胆外科收治的80例肝胆外科胆囊相关疾病患者的资料予以分析,其中44例患者予以腹腔镜胆囊切除术辅以腹壁穿刺拉钩三孔法治疗,设为研究组;另36例予以常规传统开腹手术治疗。比较2组相关手术指标、术后6、12 h以及术后1 d的疼痛评分,同时比较2组患者术后1 d恶心、呕吐程度以及术后6个月的生活质量状况。结果研究组的手术时间[(44.82±10.00)min]、肛门排气时间[(21.02±6.72)d]以及住院时间[(4.12±1.01)d]均明显短于对照组[(83.14±10.03)min、(35.07±7.43)d、(8.33±1.69)d],且术中失血量[(51.45±11.18)mL]明显少于对照组[(160.34±12.37)mL],差异均有统计学意义(P<0.05)。研究组患者术后6、12 h以及术后1 d的疼痛评分[(2.42±0.52)、(1.52±0.37)、(0.41±0.30)分]均显著低于对照组[(4.57±1.37)、(3.51±0.62)、(1.92±0.62)分],差异均有统计学意义(P<0.05)。术后1 d,研究组患者的恶心、呕吐分级明显低于对照组,差异有统计学意义(P<0.05)。术后6个月,研究组患者的生活质量GQOLI-74量表相关维度评分均明显高于对照组,差异有统计学意义(P<0.05)。结论腹腔镜胆囊切除术辅以腹壁穿刺拉钩三孔法治疗肝胆外科胆囊相关疾病,能够促进患者快速恢复,降低术后疼痛并减轻恶心、呕吐反应,安全可靠。

Objective To observe the clinical effect of laparoscopic cholecystectomy combined with abdominal wall puncture and pull three-hole method in the treatment of gallbladder related diseases in hepatobiliary surgery.Methods The data of 80 patients with hepatobiliary surgery and gallbladder-related diseases admitted to the Department of Hepatobiliary Surgery,General Hospital of Huainan Eastern Hospital Group from January 2018 to January 2020 were retrospectively selected for analysis,including 44 patients for laparoscopic cholecystectomy three hole method to treat abdominal puncture retractor,set for the team.The other 36 cases were treated with conventional laparotomy.The surgical indicators(operative time,intraoperative blood loss,anal exhaust time and length of hospital stay),pain scores at 6,12 h and 1 d after surgery were compared between the two groups,and nausea and vomiting degree at 1d after surgery and quality of life at 6 months after surgery were also compared between the two groups.Results The operation time[(44.82±10.00)min],anal exhaust time[(21.02±6.72)d]and hospitalization time[(4.12±1.01)d]in the study group were significantly shorter than those in the control group[(83.14±10.03)min,(35.07±7.43)d,(8.33±1.69)d],and intraoperative blood loss[(51.45±11.18)mL]was significantly less than that in the control group[(160.34±12.37)mL],the differences were statistically significant(P<0.05).The pain scores[(2.42±0.52),(1.52±0.37),(0.41±0.30)points]of the patients in the study group at 6,12 h and 1 d after the operation were significantly lower than those in the control group[(4.57±1.37),(3.51±0.62),(1.92±0.62)points],the differences were statistically significant(P<0.05).One day after operation,the nausea and vomiting grades of the study group was significantly lower than that of the control group,the difference was statistically significant(P<0.05).Six months after the operation,the quality of life GQOLI-74 scale related dimension scores of the patients in the study group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Laparoscopic cholecystectomy combined with abdominal wall puncture and pull three-hole method in the treatment of gallbladder-related diseases in hepatobiliary surgery can promote rapid recovery of patients,reduce postoperative pain and alleviate nausea and vomiting reaction,which is safe and reliable.