胆囊板Laennec膜间隙逆行分离联合Pringle法在困难胆囊LC术中应用(附视频)

Application of retrograde separation along space between Laennec's capsule and cystic plate combined with Pringle maneuver in difficult laparoscopic cholecystectomy(video attached)

目的探讨胆囊板Laennec膜间隙逆行分离联合Pringle法在困难胆囊腹腔镜胆囊切除术(LC)术中的临床应用价值。方法回顾性分析2018年6月至2021年12月湖南省吉首大学第一附属医院行困难胆囊LC的98例患者临床资料。其中男36例,女62例;年龄24~85岁,中位年龄49岁。患者均签署知情同意书,符合医学伦理学规定。根据手术方式将患者分为实验组(58例)和对照组(40例)。实验组采用胆囊板Laennec膜间隙逆行分离联合Pringle法行LC,对照组行传统LC。两组手术时间、术中出血量等比较采用t检验,术后并发症等比较采用Fisher确切概率法。结果实验组无中转开腹,对照组中转开腹6例,差异有统计学意义(P=0.004)。实验组平均手术时间、术中出血量、术后住院时间分别为(63±9)min、(17±6)ml、(7.1±0.9)d,明显少于对照组的(80±8)min、(47±6)ml、(7.5±0.9)d(t=-9.75,-25.25,-2.02;P<0.05)。两组术后引流量、术后肝功能、术后并发症发生率比较差异无统计学意义(P>0.05)。结论采用胆囊板Laennec膜间隙逆行分离联合Pringle法行困难胆囊LC,可有效控制术中出血,有利于安全分离和保护重要管道,减少中转开腹率,有效缩短手术时间,加速术后康复。

Objective To evaluate the clinical application value of retrograde separation along the space between Laennec's capsule and cystic plate combined with Pringle maneuver in difficult laparoscopic cholecystectomy(LC).Methods Clinical data of 98 patients undergoing LC in the First Affiliated Hospital of Jishou University from June 2018 to December 2021 were retrospectively analyzed.Among them,36 patients were male and 62 female,aged 24-85 years with a median age of 49 years.The informed consents of all patients were obtained and the local ethical committee approval was received.All patients were divided into the study group(n=58)and control group(n=40)according to surgical procedures.In the study group,LC was performed by using retrograde separation along the space between Laennec's capsule and cystic plate combined with Pringle maneuver,and conventional LC was carried out in the control group.The operation time and intraoperative blood loss between two groups were compared by t test.The incidence of postoperative complications was compared by Fisher's exact probability test.Results No conversion to open surgery was performed in the study group,and 6 cases in the control group and significant difference was observed(P=0.004).In the study group,the average operation time,intraoperative blood loss and the length of postoperative hospital stay were(63±9)min,(17±6)ml and(7.1±0.9)d,which were significantly less than(80±8)min,(47±6)ml and(7.5±0.9)d in the control group(t=-9.75,-25.25,-2.02;P<0.05).No significant differences were observed in the postoperative drainage volume,postoperative liver function and incidence of postoperative complications between two groups(P>0.05).Conclusions Application of retrograde separation along the space between Laennec's capsule and cystic plate combined with Pringle maneuver in difficult LC can effectively control the intraoperative bleeding,contribute to achieving safe separation and protecting vital tracts,reduce conversion rate to open surgery,effectively shorten operation time and accelerate postoperative recovery.