顺逆结合法腹腔镜胆囊床剥离的临床应用研究

目的 比较顺逆结合法与顺行法腹腔镜胆囊床剥离的临床效果.方法 将575例腹腔镜胆囊切除术患者按照随机数字表法随机分为A组(297例)与B组(278例),分别使用顺逆结合法与顺行法完成腹腔镜胆囊床剥离,比较两组治疗效果.结果 A、B组胆囊床剥离时间分别为(10.0±3.7)min和(13.0±3.9)min(P<0.05),出血量≥5ml分别为33例和85例(P<0.05),胆囊破裂分别为3例和10例(P<0.05),术后胆囊窝积液分别为5例和19例(尸<0.05),中转开腹率分别为3.70%(11/297)和3.96%(11/278)(P>0.05),两组均无胆管损伤及胆漏发生,A组发生术后腹腔积液1例,经保守治疗治愈.结论 顺逆结合法腹腔镜胆囊床剥离可以缩短手术时间、减少出血量、减少医源性胆囊破裂及术后胆囊窝积液,并更易掌握.

Clinical study of laparoscopic gallbladder bed dissection using retrograde plus anterograde manner

Objective To compare the efficacy of laparoscopic gallbladder bed dissection(LGBD)between retrograde plus anterograde and anterograde only manners.Methods All of 575 cases of laparoscopic cholecystectomy(LC)were randomly divided into two groups(group A and group B).Patients underwent LGBD with retrograde plus anterograde mannerin group A(297 cases)oronly with anterograde manner in group B(278 cases)respectively.The efficacy and safety were compared between two groups.Results The operative time were(10.0±3.7)min and(13.0±3.9)min in group A and group B respectively (P<0.05).There were 33 cases of bleeding volume more than 5 ml in group A with 85 cages in group B (P<0.05).Three cases of gallbladder rupture were found in group A compared with 10 cases in group B (P<0.05).Postoperative fluid collection in gallbladder bed occurred in 5 cases in group A compared with 19 cases in group B(P<0.05).The conversion rate was 3.70%(11/297)and 3.96%(11/278)in group A and group B respectively(P>0.05).One cage of abdominal fluid collection was observed in group A whichwas relieved after conservative therapy.No other complications occurred.Conclusions LGBD applying retrograde plus anterograde manner may shorten the operative time,decrease the bleeding during operation and minimize the postoperative complications.Surgeons might benefit from its advantage of easier manipulation.