Rouviere沟定位联合关键术野建立在腹腔镜胆囊切除术中的应用

Application of critical view dissection guided by Rouviere's sulcus in laparoscopic cholecystectomy

目的探讨在腹腔镜胆囊切除术(LC)中应用Rouviere沟定位联合关键术野建立的价值。方法收集2018年8月至2020年7月于上海中医药大学附属岳阳中西医结合医院接受LC治疗的232例患者的临床资料进行回顾性分析。其中采用Rouviere沟定位联合关键术野建立的方法行LC为试验组(141例),采用经胆囊三角直接建立关键术野的传统手术方法为对照组(91例)。比较两组患者手术时间、术中出血量、放置引流数、胆管损伤数、腔镜中转开腹例数、术后感染数、术后首次进食时间、术后首次排气时间及术后出院时间。结果与对照组比较,试验组手术时间短[(50.07±5.91)min vs(60.48±13.30)min,t=8.14,P<0.05],且术中出血量少[(13.42±7.93)mL vs(25.02±21.17)mL,t=5.90,P<0.05],放置引流率、胆管损伤率及术后感染率低,术后进食、排气及出院时间早,差异有统计学意义(P<0.05)。结论与传统手术方法相比,Rouviere沟定位联合关键术野建立可以缩短手术时间,减少术中出血量,降低胆管损伤概率,加速术后康复。

Objective To explore the application value of critical view dissection guided by Rouviere's sulcus in laparoscopic cholecystectomy(LC).Methods Retrospective analysis was performed on 232 patients received LC in Yueyang Hospital of Integrated Traditional Chinese and Western Medicine from August 2018 to July 2020.Patients underwent critical view dissection guided by Rouviere's sulcus were served as study group(n=141),and patients underwent traditional anatomical dissection as control group(n=91).The operation time,intraoperative bleeding,the number of drains,bile duct injury and laparoscopy converted to laparotomy,the time of first postoperative feeding and exhaust,the number of postoperative infections,the time of discharge were compared between two groups.Results Compared with the control group,the study group had shorter operation time[(50.07±5.91)min vs(60.48±13.30)min,t=8.14,P<0.05],lower intraoperative bleeding[(13.42±7.93)mL vs(25.02±21.17)mL,t=5.90,P<0.05],lower placement drainage rate,bile duct injury rate,postoperative infection rate,and earlier postoperative feeding,exhaust,and discharge time,with statistically significant differences(P<0.05).Conclusion Compared with traditional anatomical dissection method,critical view dissection guided by Rouviere's sulcus in LC can shorten surgical time,reduce intraoperative blood loss,reduce the probability of bile duct injury,and accelerate postoperative recovery,which is worthy of clinical application and promotion.