胆囊后三角与胆囊三角入路在腹腔镜胆囊切除术中的应用效果比较

Comparison of effects posterior triangle approach and gallbladder triangle approach in laparoscopic cholecystectomy

目的:比较胆囊后三角与胆囊三角入路在腹腔镜胆囊切除术(LC)中的应用效果。方法:选取80例拟行LC治疗的胆囊疾病患者为研究对象,按随机数字表法分为对照组和研究组各40例。对照组采用胆囊三角入路行LC治疗,研究组采用胆囊后三角入路行LC治疗。比较两组围术期相关指标(手术时间、术中出血量、术后肠道功能恢复时间、住院时间)水平、手术前后炎性因子[白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)]水平、并发症发生率及转开腹率。结果:研究组手术时间、术后肠道功能恢复时间及住院时间均短于对照组,术中出血量少于对照组,术后3 d的TNF-α、hs-CRP、IL-6水平均低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率、转开腹率均低于对照组,差异有统计学意义(P<0.05)。结论:与传统胆囊三角入路相比,经胆囊后三角入路行LC治疗胆囊疾病患者,可缩短手术时间、术后肠道功能恢复时间及住院时间,减少术中出血量,降低术后炎性因子水平、并发症发生率及转开腹率,安全性较好。

Objective:To compare effects posterior triangle approach and gallbladder triangle approach in laparoscopic cholecystectomy(LC).Methods:80 patients with gallbladder disease who were to be treated with LC were selected as the research objects,and were divided into control group and study group by using the random number table method,40 cases in each group.The control group was treated with LC through the gallbladder triangle approach,while the study group was treated with LC through the posterior triangle approach.The perioperative related indicator levels(operation time,intraoperative blood loss,postoperative intestinal function recovery time、hospitalization time),the inflammatory factor levels[interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α),high-sensitivity C-reactive protein(hs-CRP)]before and after the surgery,the incidence of complications and the rate of conversion to laparotomy were compared between the two groups.Results:The operation time,the postoperative intestinal function recovery time and the hospitalization time in the study group were shorter than those in the control group;the intraoperative blood loss was less than that in the control group;the levels of TNF-α,hs-CRP and IL-6 at 3 days after the surgery were lower than control group;and the differences were statistically significant(P<0.05).Further,the incidence of complications and the rate of conversion to laparotomy in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusions:Compared with the traditional gallbladder triangle approach,LC through the posterior triangle approach in the treatment of the patients with cholecystolithiasis and chronic cholecystitis can shorten the operation time,the postoperative bowel function recovery time and the hospitalization time,reduce the intraoperative blood loss,and reduce the amount of intraoperative blood loss,the postoperative inflammatory factor levels,the complication rate and the rate of conversion rate laparotomy with good safety.