腹腔镜胆囊切开取石术中圈套器套扎胆囊壁切口法与丝线缝合胆囊壁切口法的临床疗效对比

Comparison of clinical efficacy between ligation of gallbladder wall with endoloop and with thread suture in cholecystolithotomy

目的比较腹腔镜胆囊切开取石术中圈套器套扎胆囊壁切口法与丝线缝合胆囊壁切口法的临床疗效。方法回顾性分析同济大学附属东方医院胆石中心2020年1月-2022年1月收治的206例胆石病患者的临床资料,按照手术方式分为圈套组(n=86)和缝合组(n=120),对比两组患者手术情况、手术并发症情况和术后胆囊恢复情况。结果所有患者顺利完成手术,圈套组手术时间较缝合组短[(19.98±2.31)和(34.97±2.21)min],差异有统计学意义(P<0.01)。圈套组术中出血量较缝合组少[(5.29±1.00)和(16.98±2.17)mL],差异有统计学意义(P<0.01);两组患者住院时间[(2.28±0.75)和(3.46±0.66)d]比较,差异有统计学意义(P<0.01)。两组患者手术并发症比较,差异无统计学意义(P>0.05),圈套组术后无胆囊内血凝块形成和胆囊急性炎症发生。两组患者术后胆囊结石复发率比较,差异无统计学意义(P>0.05)。圈套组术前与术后的胆囊排空率和胆囊壁厚度比较,差异无统计学意义(P>0.05)。结论圈套器套扎胆囊壁切口法安全可行,可明显缩短手术时间和住院时间,减少术中出血量,避免胆囊切开取石术后胆囊内血凝块形成及急性炎症的发生,值得临床推广。

Objective To compare the clinical efficacy of two surgical methods between ligation of gallbladder wall with endoloop and with thread suture in cholecystolithotomy.Methods Included in this study were 206 patients with gallbladder stones who received surgical treatment from January 2020 to January 2022.They were divided into endoloop group(n=86),and the thread suture group(n=120)as control.The operation conditions,postoperative complications and postoperative recovery were compared between the two groups.Results The operation was accomplished successfully in both groups.The operation time in the endoloop group was shorter than that in the thread suture group[(19.98±2.31)min vs(34.97±2.21)min(P<0.01)].The intraoperative blood loss in the endoloop group was less than that in the thread suture group[(5.29±1.00)mL vs(16.98±2.17)mL(P<0.01)].The hospital stay in the endoloop group was shorter than that in the thread suture group[(2.28±0.75)d vs(3.46±0.66)d(P<0.01)].There was no significant difference in the surgical complications and recurrence of gallstone between the two groups(P>0.05).Moreover,neither blood clots or acute inflammation of the gallbladder wall were found in the endoloop group after the operation.There was no significant difference in both thickness and evacuation rate of the gallbladder between pre-operative and post-operative in the endoloop group(P>0.05).Conclusion In view of the safety and practicability,ligation of the gallbladder wall incision with the endoloop has obvious advantages of reducing both the operative time and the hospital stay time and low incidence of gallbladder wall hematoma or inflammation.Based on the above advantages,it is worthy of clinical promotion and application.