腹壁穿刺拉钩三孔法辅助腹腔镜胆囊切除术治疗肝胆外科胆囊疾病的临床效果

Clinical Effect of Laparoscopic Cholecystectomy Assisted by Abdominal Wall Puncture and Pull Hook Three-hole Method in the Treatment of Gallbladder Diseases in Hepatobiliary Surgery

目的:探讨腹壁穿刺拉钩三孔法辅助腹腔镜胆囊切除术(LC)治疗肝胆外科胆囊疾病的临床效果。方法:选取2021年1月—2023年6月山东省荣军总医院肝胆外科收治的胆囊疾病患者76例作为研究对象,随机分为观察组和对照组,各38例。两组均采用LC治疗,对照组使用常规三孔法,观察组使用腹壁穿刺拉钩三孔法。比较两组手术指标、术后疼痛情况及镇痛药物使用率、并发症发生率、炎性因子。结果:观察组手术时间、胆囊剥离时间、住院时间均短于对照组,差异有统计学意义(P<0.001);两组术中出血量、术后肛门排气时间、中转开腹手术率、引流管留置率比较,差异无统计学意义(P>0.05);观察组术后6、12、24、48 h的视觉模拟评分及镇痛药物使用率均低于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05);术后,两组白细胞计数、白细胞介素-6、肿瘤坏死因子-α、C反应蛋白水平均降低,观察组低于对照组,差异有统计学意义(P<0.05)。结论:腹壁穿刺拉钩三孔法辅助LC术治疗肝胆外科胆囊疾病的临床效果显著,手术创伤小、时间短,术后疼痛及炎性反应轻,且安全性较高。

Objective:To investigate the clinical effect of laparoscopic cholecystectomy(LC)assisted by abdominal wall puncture and pull hook three-hole method in the treatment of gallbladder diseases in hepatobiliary surgery.Methods:Seventy-six patients with gallbladder diseases admitted to the Department of Hepatobiliary Surgery,Shandong Rongjun General Hospital from January 2021 to June 2023 were selected as the study subjects,and were randomly divided into the observation group and the control group,each with thirty-eight cases.Both groups were treated with LC,and the control group used the conventional three-hole method,while the observation group used the abdominal wall puncture and pull hook three-hole method.The surgical indexes,postoperative pain and analgesic drug utilization rate,complication rate and inflammatory factor of the two groups were compared.Results:The operation time,cholecystectomy time and hospitalization time of the observation group were shorter than those of the control group,and the difference was statistically significant(P<0.001);there were no significant differences in intraoperative bleeding,postoperative anal defecation time,rate of intermediate open surgery and retention rate of drainage tubes between the two groups(P>0.05);the Visual Analog Scale scores and analgesic drug use rate of the observation group were lower than those of the control group at 6,12,24,and 48 h postoperatively,and the difference was statistically significant(P<0.05);there was no significant difference in complication rates between the two groups(P>0.05);after surgery,the white blood cell count,interleukin-6,tumor necrosis factor-α,C-reactive protein levels were reduced in both groups,and the observation group was lower than the control group,with a statistically significant difference(P<0.05).Conclusion:The clinical effect of LC assisted by abdominal wall puncture and pull hook three-hole method in the treatment of gallbladder disease in hepatobiliary surgery is remarkable,with less trauma,shorter operation time,less postoperative pain and inflammatory reaction,and higher safety.