CVS理念在有腹部手术史患者行急诊腹腔镜胆囊切除中的应用体会

To Observe the Clinical Effect of Elective and Emergency Laparoscopic Surgery in Gallstone Patients with a History of Ab-dominal Surgery

目的探究有腹部手术史病人应用安全性关键视角(critical view of safety,CVS)技术理念行急诊腹腔镜胆囊切除术(LC)的应用价值。方法回顾性分析既往有腹部手术史接受急诊LC手术患者48例,依据患者手术是否施行CVS理念将患者分为CVS组和非CVS组。其中CVS组28例,非CVS组20例,分析患者手术时间、术中出血量、术中胆管损伤、临近脏器损伤、胃肠功能恢复时间、总住院时间、术后腹腔引流量、术后拔管时间、总住院费用、术后出血、术后胆漏发生率等情况。结果所有患者均顺利完成手术,两组患者术中出血量、术后胃肠功能恢复时间、术后出血、总住院费用、总住院时间等无明显差异;CVS组手术时间稍长于非CVS组,而术后腹腔引流量、术后拔管时间CVS组显著低于非CVS组,差异有统计学意义(P<0.05);此外,CVS组发生胆管损伤、临近脏器损伤、术后胆漏等并发症发生率显著低于非CVS组,差异有统计学意义(P<0.05)。结论CVS技术理念的应用可有效提高有腹部手术史患者LC手术的安全性,尤其对于急诊手术患者,可显著降低术后并发症发生率,该理念的应用有助于促进患者康复、提高手术安全性。

Objective This study aims to investigate the value of applying the Critical View of Safety(CVS)technique in lap-aroscopic cholecystectomy(LC)for patients with a history of abdominal surgery.Method This study retrospectively analyzed 48 cases of patients with a history of abdominal surgery who underwent emergency LC.Patients were divided into CVS and non-CVS groups ac-cording to whether the CVS technique was implemented during the operation.There were 28 cases in the CVS group and 20 in the non-CVS group.We analyzed surgical time,intraoperative blood loss,biliary tract injury during surgery,damage to nearby organs,time to gastrointestinal function recovery,total hospital stay duration,postoperative abdominal drainage,time to tube removal,total hospital costs,postoperative bleeding,and the incidence of postoperative bile leakage.Results All patients successfully completed the surger-y.There were no significant differences between the two groups in terms of intraoperative blood loss,postoperative gastrointestinal func-tion recovery time,postoperative bleeding,total hospital costs,and total hospital stay duration.The surgical time in the CVS group was slightly longer than that in the non-CVS group,while postoperative abdominal drainage and time to tube removal in the CVS group were significantly lower than in the non-CVS group,the difference being statistically significant(P<0.05).Moreover,the incidence of complications such as biliary tract injury,damage to nearby organs,and postoperative bile leakage in the CVS group was significantly lower than in the non-CVS group,the difference being statistically significant(P<0.05).Conclusion The application of the CVS technique can effectively improve the safety of LC in patients with a history of abdominal surgery,particularly in emergency surgery pa-tients.It can significantly reduce the incidence of postoperative complications.The application of this technique contributes to patient recovery and enhances surgical safety.