摘要:
目的 比较不同Calot三角解剖入路在腹腔镜胆囊切除术(LC)中的应用效果.方法 根据不同Calot三角解剖入路方式分组,在行LC术治疗胆囊结石伴慢性胆囊炎患者时,100例采用胆囊后三角解剖入路(观察组),另100例采用胆囊三角入路(对照组),采用免疫比浊法测定血清C反应蛋白(CRP),采用ELISA法测定血清白细胞介素-6(IL-6)、白介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)水平,采用视觉模拟评分(VAS)工具评估疼痛程度,比较两组手术指标及手术前后血清细胞因子水平变化.结果 在手术中,发现观察组胆囊周围出现粘连53例,对照组50例;两组无胆囊粘连患者组间各手术指标、手术并发症和中转开腹发生率比较均无显著性差异(P>0.05);观察组粘连患者手术时间、术中出血量、术后肠功能恢复时间、住院时间和术后VAS评分分别为(29.4± 4.3)min、(33.9±4.6)ml、(26.0±4.2)h、(6.0±1.0)d和(4.0±1.5)分,均显著少于或轻于对照组粘连患者[(59.1±5.5)min、(45.6±4.1)ml、(30.3±4.5)h、(8.4±1.0)d和(4.8±1.3)分,P0.05);The operation time,intraoperative bleeding,time for intestinal function recovery after operation,hospital stay and postoperative visual analogue scale(VAS)score of pain in patients with adhesion in the observation group were(29.4±4.3)min,(33.9±4.6)ml,(26.0±4.2)h,(6.0± 1.0)d,and(4.0±1.5),significantly shorter,lesser or lower than those in patients with adhesion in the control group [(59.1 ±5.5)min,(45.6 ±4.1)ml,(30.3 ±4.5)h,(8.4 ±1.0)d,and(4.8 ±1.3),P<0.05];There was not incidence of complications or conversion to laparotomy in patients with adhesion around gallbladder in the observation group, while they were 8.0% and 8.0% in patients with adhesion around gallbladder in the control group(P<0.05);Serum levels of C reactive protein,interleukin-6,interleukin -8 and tumor necrosis factor α after operation in the observation group were significantly lower than those in the control group(P<0.05). Conclusion Posterior gallbladder triangle anatomical approach can significantly reduce bleeding in patients with gallbladder adhesion, significantly decrease the incidence of complications and the rate of conversion to open operation. In laparoscopic cholecystectomy,the gallbladder adhesion needs to be observed closely and dealt with properly.