侧方入路与顺/逆行剥离腹腔镜胆囊切除术治疗急性胆囊炎并胆囊结石的临床比较

Clinical comparison of lateral approach and antegrade/retrograde dissection laparoscopic cholecystectomy for acute cholecystitis with gallstones

目的比较侧方入路与顺/逆行剥离腹腔镜胆囊切除术治疗急性胆囊炎并胆囊结石的临床效果与安全性。方法前瞻性研究2017年3月至2020年3月收治的80例急性胆囊炎并胆囊结石患者临床资料,随机分为侧方组、顺/逆行组,各40例,分别行侧方入路、顺/逆行剥离腹腔镜胆囊切除术。使用SPSS22.0统计学软件分析数据,术后并发症等计数资料采用χ^(2)检验,围手术期各项指标等计量资料以(-x±s)表示,采用独立样本t检验,以P<0.05为差异有统计学意义。结果侧方组术中出血量及术中胆囊破裂发生率低于顺/逆行组(P<0.05)。侧方入路组引流管留置时间、引流量、术后住院时间低于顺/逆行组(P<0.05)。两组患者术后均未见胆道损伤、胆瘘、大出血、腹腔感染等并发症发生。两组患者均获得有效随访,平均随访时间(1.3±0.4)年,随访期间均未见结石复发。结论与顺/逆行剥离胆囊相比,侧方入路腹腔镜胆囊切除能够降低急性胆囊炎并胆囊结石患者术中创伤、促进术后恢复。

Objective To compare the clinical efficacy and safety of laparoscopic cholecystectomy with lateral approach and antegrade/retrograde dissection in the treatment of acute cholecystitis and cholecystolithiasis.Methods The clinical data of 80 patients with acute complicated with gallstones admitted from March 2017 to March 2020 were prospectively studied.They were selected and randomly divided into lateral group and antegrade/retrograde group,with 40 cases in each group.Laparoscopic cholecystectomy was performed by lateral approach and anterograde/retrograde stripping respectively.SPSS 22.0 statistical software was used to analyze the data.T Postoperative complications and other counting data were analyzed by(χ^(2) test)was used.Perioperative indicators and other measurement data were expressed as(-x±s)and independent sample t test was used.Results The intraoperative blood loss and the incidence of gallbladder rupture in the lateral group were lower than those in the antegrade/retrograde group(P<0.05).The indwelling time,drainage volume and postoperative hospital stay of lateral approach drainage tube were lower than those of the antegrade/retrograde group(P<0.05).There were no complications such as bile duct injury,biliary fistula,massive hemorrhage and abdominal infection in the two groups.The average follow-up time was(1.3±0.4)years.No stone recurrence was found during the follow-up.Conclusion Compared with antegrade/retrograde gallbladder dissection,lateral laparoscopic cholecystectomy can reduce the intraoperative trauma and promote postoperative recovery in patients with acute cholecystitis and cholecystolithiasis.