Rouviere沟引导定向联合胆囊后三角入路腹腔镜胆囊切除术治疗胆囊良性疾病研究*

目的 探讨Rouviere沟引导定向联合胆囊后三角入路与常规腹腔镜胆囊切除术(LC)治疗胆囊良性疾病患者的临床效果。方法 2018年3月～2019年3月我院诊治104例胆囊良性疾病患者,被随机分为观察组52例和对照组52例,分别采取常规LC术或以Rouviere沟引导定向联合胆囊后三角入路行LC术治疗。结果 观察组中转开腹1例(1.9%),而对照组6例(11.5%),导致对照组手术时间、术中出血量、术后下床活动时间和住院时间与观察组比,均有显著性差异[分别为(113.5±5.1)min、(34.5±5.4)mL、(3.4±0.9)d和(8.0±1.2)d对(75.1±5.2)min、(13.4±5.1)mL、(1.4±0.8)d和(3.8±1.0)d,P＞0.05];术后12 h和24 h,对照组VAS评分分别为(4.8±1.0)分和(5.2±1.3)分,显著大于观察组【分别为(2.8±1.0)分和(3.1±1.2)分, P＞0.05】;手术前后,两组血清AST、ALT、TBIL和ALP水平无显著性差异(P>0.05);术后,观察组胆漏、胆管损伤、切口感染、腹腔感染和腹胀发生率分别为3.8%、0.0%、1.9%、1.9%和1.9%,显著低于对照组的3.8%、9.6%、3.8%、3.8%和3.8%(P<0.05)。结论 与常规LC术相比,以Rouviere沟引导定向联合胆囊后三角入路行LC术治疗胆囊良性疾病患者能够提供手术成功率,减轻疼痛,降低并发症发生风险,具有较高的临床应用价值。

A comparative study of Rouviere sulcus-guided posterior triangle approach and conventional laparoscopic cholecystectomy for the treatment of patients with benign gallbladder diseases

Objective The aim of this study was to explore the clinical Efficacy of Rouviere sulcus guided posterior triangle approach and conventional laparoscopic cholecystectomy(LC)in the treatment of patients with benign gallbladder diseases.Methods A total of 104 patients with benign gallbladder diseases were recruited in our hospital between March 2018 and March 2019,and they were randomly divided into observation group(n=52)and control group(n=52).The patients in the control group underwent LC,and those in the observation underwent LC by Rouviere groove-guided orientation and posterior triangle gallbladder approach.The visual analogue score(VAS)at different postoperative time and the complications during hospitalization in the two groups was recorded.Results One patient(1.9%)in the observation group,while six(11.5%)patients in the control converted to open surgery during LC,which led to the operation time,intraoperative bleeding volume,time for out-of-bed activity after operation and hospitalization stay in the control much longer or greater than those in the observation[(113.5±5.1)min,(34.5±5.4)mL,(3.4±0.9)d and(8.0±1.2)d vs.(75.1±5.2)min,(13.4±5.1)mL,(1.4±0.8)d and(3.8±1.0)d,respectively,P>0.05];at 12 h and 24 h after operation,the VAS score in the control group were(4.8±1.0)and(5.2±1.3),significantly greater than[(2.8±1.0)and(3.1±1.2),respectively,P>0.05]in the observation;there were no significant differences as respect to the biochemical parameters between the two groups(P>0.05);after operation,the incidences of bile leakage,bile duct injuries,incision infection,peritonitis and abdominal distention in the observation group were 3.8%,0.0%,1.9%,1.9%and 1.9%,significantly lower than 3.8%,9.6%,3.8%,3.8%and 3.8%(P<0.05)in the control.Conclusion The LC with Rouviere sulcus-guided posterior triangle approach for the treatment of patients with benign gallbladder diseases might boost the operation success and reduce the operation-related complications,which worth further investigation.