改良经腹白线入路腹腔镜胆囊切除术的临床疗效评价

Efficacy evaluation of modified transabdominal linea alba approach for laparoscopic cholecystectomy

目的:探讨改良经腹白线入路腹腔镜胆囊切除术的安全性和治疗效果。方法:选取皖南医学院弋矶山医院2020年12月-2021年6月住院接受腹腔镜胆囊切除手术(LC)的胆囊结石或胆囊良性息肉患者40例,随机分为对照组20例进行传统三孔法LC,观察组20例进行改良经腹白线入路LC;对比两组手术指标、视觉模拟评分(VAS)、疼痛数字评分(NRS)、住院时间以及主刀医生肩背部疲劳程度等方面。结果:两组患者性别、年龄和BMI相比,差异无统计学意义(P>0.05),且均顺利完成LC手术,术后恢复良好,无出血、感染、胆瘘等并发症发生;观察组术中出血量、手术时间、住院时间与对照组相比差异无统计学意义(P>0.05);观察组术后第一天VAS评分(1.85±1.26)分,低于对照组的(3.25±1.68)分(P=0.005),NRS疼痛评分(1.75±0.85)分,低于对照组的(3.15±1.42)分(P=0.001);观察组主刀医生肩背部疲劳程度明显轻于对照组(P<0.05)。结论:改良经腹白线入路腹腔镜胆囊切除术与传统三孔法LC相比,患者疼痛更轻、创伤更小,并能减轻主刀医生肩背部疲劳程度,值得临床推广和应用。

Objective:To investigate the safety and therapeutic effect of modified transabdominal linea alba approach on laparoscopic cholecystectomy.Methods:A total of 40 patients with gallstones or benign polyps of the gallbladder who were admitted to Yijishan Hospital,Wannan Medical University from December 2020 to June 2021 for laparoscopic cholecystectomy(LC)were collected and divided into two groups according to random number table method:Surgical indexes,visual analogue scale(VAS),digital pain score(NRS),length of hospital stay,and shoulder and back fatigue degree of the surgeon were compared between the control group(LC with traditional three-hole method,n=20 cases)and the observation group(LC with modified transabdominal linen albicolor approach,n=20 cases).Results:There were no significant differences in gender,age,or BMI between the two groups(P>0.05),and the LC surgery was successfully completed,and the postoperative recovery was good,without bleeding,infection,biliary fistula and other complications.The intraoperative blood loss,operation time and hospital stay of the observation group were not significantly different from those of the control group(P>0.05),but the VAS and NRS pain scores on the first postoperative day were significantly lower than those in the control group(3.25±1.68 vs.1.85±1.26,P=0.005;3.15±1.42 vs.1.75±0.85,P=0.001);In addition,the shoulder and back fatigue of the surgeon in the observation group was significantly lighter than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:LC with modified transabdominal linea alba approach,compared with LC with the traditional three-hole method,has less pain and trauma,and can reduce the surgeon shoulder and back fatigue,worthy of clinical promotion and application.