一种改良Trocar入路腹腔镜胆囊切除术的临床优势分析

Analysis of the clinical advantages of an modified trocar approach for laparoscopic cholecystectomy

目的:通过与常规三孔法腹腔镜胆囊切除术(LC)进行对比,分析改良Trocar入路LC的临床优势。方法:回顾性分析2015年1月至2023年9月于温州医科大学附属第一医院行改良Trocar入路LC(改良组)的202例胆囊良性病变患者的临床资料,其中男性84例,女性118例,年龄(49.58±13.03)岁。纳入同期行常规三孔法LC的606例胆囊良性病变患者作为对照组,其中男性245例,女性361例,年龄(50.99±12.55)岁。比较两组患者的手术时间、中转四孔法率、术后并发症、术后住院时间、术后疼痛评分和术后满意度评分等指标。结果:两组患者均无严重并发症发生。改良组有3例(1.5%,3/202)中转四孔法,对照组有7例(1.2%,7/606)中转四孔法,两组中转四孔法率比较,差异无统计学意义( P>0.05)。改良组与对照组患者的手术时间分别为(40.28±13.51)min和(40.38±18.75)min,差异无统计学意义( P>0.05)。与对照组相比,改良组患者术后数字评分量表评分更低[(2.49±1.23)分比(3.02±1.48)分],术后住院时间更短[(2.87±0.93)d比(3.80±1.31)d],Kiyak评分更高[(4.31±0.66)分比(4.15±0.63)分],差异均具有统计学意义(均 P<0.05)。 结论:改良Trocar入路LC与常规三孔法LC具有同样的安全性,但改良Trocar入路LC术后住院时间更短、疼痛更轻、疤痕更隐蔽、患者满意度更高。

Objective To analyze the clinical advantages of the modified Trocar approach in laparoscopic cholecystectomy(LC)compared to the conventional three-hole approach.Methods Clinical data of 202 patients undergoing the modified Trocar approach LC(the modified group)at the First Affiliated Hospital of Wenzhou Medical University from January 2015 to September 2023 were retrospectively analyzed,including 84 males and 118 females patients,aged(49.58±13.03)years old.The conventional group enrolled 606 patients,including 245 males and 361 females,aged(50.99±12.55)years old.The operative time,conversion to four-hole approach,postoperative complications,hospital stay,pain score,and satisfaction score were compared between the groups.Results No severe complications occurred in either group.In modified group,three cases(1.5%,3/202)required conversion to four-hole approach,while in conventional group,seven(1.2%,7/606)required conversion,with one case conversed to open surgery(P>0.05).The operative time in modified and conventional groups were(40.28±13.51)min and(40.38±18.75)min,respectively(P>0.05).The postoperative pain scores were 2.49±1.23 and 3.02±1.48,respectively(t=5.05,P<0.001).The average postoperative hospital stays were(2.87±0.93)d and(3.80±1.31)d,respectively(t=11.05,P<0.001).The postoperative Kiyak satisfaction scores were 4.31±0.66 and 4.15±0.63,respectively(t=2.93,P=0.004).Conclusion The safety of modified Trocar approach is comparable to that of conventional three-hole approach.The modified approach showed a shorter postoperative hospital stay,less pain,better scars,and higher patient satisfaction.