经胆囊后三角解剖入路腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎效果研究

Study on the Curative Effect of Laparoscopic Cholecystectomy through the Posterior Triangular Anatomical Approach of Gallbladder in the Treatment of Cholecystolithiasis with Chronic Cholecystitis

目的:探究胆囊结石伴慢性胆囊炎治疗中经胆囊后三角解剖入路腹腔镜胆囊切除术的效果。方法:选取2019年1月-2021年5月于北京丰台区中医医院拟行腹腔镜胆囊切除术的102例胆囊结石伴慢性胆囊炎患者,根据奇偶数列法将患者分成研究组和常规组,每组51例。研究组采用经胆囊后三角解剖入路,常规组采用经胆囊三角解剖入路。比较两组手术相关指标、并发症发生情况及炎症因子水平。结果:研究组和对照组转开腹率分别为0和7.84%(4/51),两组转开腹率比较,差异有统计学意义(P<0.05)。研究组术中失血量少于常规组,手术时间短于常规组,差异均有统计学意义(P<0.05)。研究组并发症发生率低于常规组,差异有统计学意义(P<0.05)。术后24 h,两组IL-6、TNF-α、CRP水平高于术前,但研究组均低于常规组,差异均有统计学意义(P<0.05)。结论:胆囊结石伴慢性胆囊炎患者在腹腔镜胆囊切除术治疗中,经胆囊后三角解剖入路能提升手术效果,缓解炎症反应,减少并发症,值得普及推广应用。

Objective:To explore the effect of laparoscopic cholecystectomy through the posterior triangular anatomical approach of gallbladder in the treatment of cholecystolithiasis with chronic cholecystitis.Method:A total of 102 patients with cholecystolithiasis complicated with chronic cholecystitis who planned to underwent laparoscopic cholecystectomy in Beijing Fengtai District Traditional Chinese Medicine Hospital from January 2019to May 2021 were selected,and they were divided into study group and conventional group according to odd and even list method,with 51 patients in each group.The study group was treated with posterior triangular anatomical approach of gallbladder,the conventional group was treated with gallbladder triangle approach.Surgery related indexes,complications and inflammatory factors were compared between two groups.Result:The conversion to open cholecystectomy rates of the study group and the conventional group were 0 and 7.84%(4/51),respectively,there was significant difference in the conversion to open cholecystectomy rates between two groups(P<0.05).The intraoperative blood loss of the study group was less than that of the conventional group,and the surgical time of the study group was shorter than that of the conventional group,the differences were statistically significant(P<0.05).The complication rate of the study group was lower than that of the conventional group,the difference was statistically significant(P<0.05).24 h after surgery,the levels of IL-6,TNF-αand CRP of both groups were higher than those before surgery,but those of the study group were lower than those of the conventional group,the differences were statistically significant(P<0.05).Conclusion:In the treatment of laparoscopic cholecystectomy patients with cholecystolithiasis with chronic cholecystitis,the posterior triangular anatomical approach of gallbladder can improve the surgical effect,relieve inflammatory reactions,reduce complications,which is worthy of popularization and application.