腹腔镜胆囊切除术中特意分离结扎胆囊动脉的必要性分析

目的:探讨腹腔镜胆囊切除术特意分离结扎胆囊动脉的必要性。方法:随机选取2015年1月至2016年6月采用"腹腔镜非特异分离结扎胆囊动脉"(非特异法)60例患者(A组)与传统腹腔镜胆囊切除术的60例患者(B组),对比两组手术时间、术中出血量、生物夹使用数量、术后住院时间、中转率等情况。结果:A组无一例中转开腹;B组中转3例,中转率5%,均为胆囊炎症期,三角区水肿、粘连严重,分离寻找胆囊动脉时因渗血多而影响视觉,分离、解剖三角区时分离钳不小心划破、撕断血管大出血被迫中转开腹止血。A组术后无胆漏患者,B组术后2例出现胆漏;两组均无肝外胆道严重损伤及术后大出血等严重并发症发生。两组手术时间、术中出血量、生物夹使用数量、术后住院时间差异有统计学意义(P0.05)。结论:与"传统法"相比,"非特异法"具有手术时间短、出血少、手术耗材使用少等优势,腹腔镜胆囊切除术中可不必特意分离结扎胆囊动脉。

The necessity of separating and ligation of the cystic artery in laparoscopic cholecystectomy

Objective:To explore the necessity of separating and ligation of the cystic artery in laparoscopic cholecystectomy. Methods:From Jan. 2015 to Jun. 2016,120 patients were randomly selected,including 60 patients with"non specific separation of the cystic artery" ( nonspecific method,group A) and 60 patients with conventional laparoscopic cholecystectomy ( traditional method,group B) ,operative time,intraoperative blood loss,the number of biological clamps,postoperative hospital stay and conversion rate were com-pared between the two groups. Results:No conversion to laparotomy occurred in group A,while 3 cases of conversion (5%) were found in group B,the conversion reasons included inflammation,edema of Calot triangle,severe adhesion,impaired vision caused by errhysis, blood vessels injury. There was no one with bile leakage in group A and 2 cases of postoperative bile leakage in group B. There were no serious complications in the two groups such as severe extrahepatic biliary injury or postoperative hemorrhage. No significant differences were found between the two groups in the operation time,intraoperative blood loss,the number of used biological clamps and postopera-tive hospital stay (P<0. 05). Conclusions:Compared with traditional method,nonspecific method is associated with shorter operation time,less bleeding,fewer surgical consumables,there is no need to deliberately separate and ligate the cystic artery in laparoscopic chol-ecystectomy.