腹腔镜辅助切除伴炎症水肿困难胆囊的难点与对策分析

Analysis on difficulties and countermeasures of laparoscopic-assisted resection of difficult gallbladder with inflammation and edema

目的研究腹腔镜辅助切除伴炎症水肿困难胆囊的难点与对策。方法选取2018年1月—2021年1月收治的急性胆囊炎患者120例,以单双数字法将其分成微创组60例及开腹组60例。开腹组开展常规开腹胆囊切除术治疗,微创组则开展腹腔镜胆囊切除术(LC)治疗。对比两组各项手术指标、术后并发症发生情况以及血清CRP、白细胞计数、粒细胞百分比变化情况。结果微创组手术时长、术中失血量、肠鸣音恢复时间、肛门排气时间、引流管留置时间以及住院时间分别为(61.89±3.56)min、(30.79±2.16)mL、(17.89±2.47)h、(23.86±1.89)h、(2.45±0.51)d、(4.72±0.75)d,相较于开腹组的(80.03±6.18)min、(42.12±2.49)mL、(32.12±3.69)h、(40.57±4.26)h、(3.66±0.72)d、(7.06±0.94)d更低(均P<0.05)。在并发症总发生率方面对比,微创组低于开腹组(3.33%对13.33%)(P<0.05)。术前1 d两组血清CRP以及白细胞计数、粒细胞百分比对比均不明显(均P>0.05);术后1 d微创组血清CRP以及白细胞计数、粒细胞百分比分别为(32.84±4.19)mg/L、(12.46±2.30)×10^(9)/L、(77.86±7.28)%,相较于开腹组的(51.78±6.26)mg/L、(15.17±3.06)×10^(9)/L、(83.47±8.09)%更低(均P<0.05)。结论腹腔镜辅助切除伴炎症水肿困难胆囊的效果显著,可促进患者早日康复,降低术后并发症发生风险,减轻炎症反应。

Objective To study the difficulties and countermeasures of laparoscopic-assisted resection of difficult gallbladder with inflammation and edema.Methods A total of 120 patients with acute cholecystitis admitted to the hospital from January 2018 to January 2021 were selected.They were divided into a minimally invasive group(n=60)and an open group(n=60)by single and double digit method.Conventional open cholecystectomy was performed in the open group,and laparoscopic cholecystectomy(LC)was performed in the minimally invasive group.The surgical indicators,postoperative complications,serum CRP,white blood cell count,and percentage of granulocytes were compared between the two groups.Results In the minimally invasive group,the operation duration,intraoperative blood loss,intestinal sound recovery time,anal exhaust time,indwelling drainage tube time,and hospital stay were(61.89±3.56)min,(30.79±2.16)mL,(17.89±2.47)h,(23.86±1.89)h,(2.45±0.51)d,and(4.72±0.75)d,respectively,which were lower than those in the open group,(80.03±6.18)min,(42.12±2.49)mL,(32.12±3.69)h,(40.57±4.26)h,(3.66±0.72)d,and(7.06±0.94)d,respectively(all P<0.05).The total incidence of complications in the minimally invasive group was lower than that in the open group(3.33%vs.13.33%)(P<0.05).There were no significant differences in serum CRP,white blood cell count,and percentage of granulocytes between the two groups 1 d before operation(all P>0.05).One day after surgery,the serum CRP,white blood cell count,and percentage of granulocytes in the minimally invasive group were(32.84±4.19)mg/L,(12.46±2.30)×10^(9)/L,and(77.86±7.28)%,respectively,lower than those in the open group,(51.78±6.26)mg/L,(15.17±3.06)×10^(9)/L,and(83.47±8.09)%,respectively(all P<0.05).Conclusion Laparoscopic-assisted resection of difficult gallbladder with inflammation and edema has a significant effect,which can promote the early recovery of patients,reduce the risk of postoperative complications,and reduce inflammatory reaction.