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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

37

期数:

2020年6

页码:

535-539

栏目:

临床研究

出版日期:

2020-06-05

文章信息/Info

Title:

Comparison of the effect of laparoscopic cholecystectomy through posterior and anterior triangle approaches of gallbladder in the treatment of cholecystolithiasis complicated with chronic cholecystitis

作者:

赵　刚¹; 张朝阳¹; 乔师师²; 李胜伟¹; 冯大猛¹; 李鹏哲¹

（1.汝州市第一人民医院肝胆疝外科，河南　汝州　467500；2.郑州大学第一附属医院肝胆胰外科，河南　郑州　450052）

Author(s):

ZHAO Gang¹; ZHANG Zhaoyang¹; QIAO Shishi²; LI Shengwei¹; FENG Dameng¹; LI Pengzhe¹

(Department of Hepatobiliary and Herniary Surgery,the First People′s Hospital of Ruzhou,Ruzhou 467500,Henan Province,China;2.Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China)

关键词:

胆囊结石; 慢性胆囊炎; 腹腔镜胆囊切除术; 胆囊粘连

Keywords:

cholecystolithiasis; chronic cholecystitis; laparoscopic cholecystectomy; gallbladder adhesion

分类号:

R575.6

DOI:

10.7683/xxyxyxb.2020.06.007

文献标志码:

A

摘要:

目的　比较胆囊后三角入路与胆囊前三角入路腹腔镜胆囊切除术（LC）治疗胆囊结石伴慢性胆囊炎的临床效果。方法　选择2017年1月至2018年12月汝州市第一人民医院收治的胆囊结石伴慢性胆囊炎患者180例为研究对象，所有患者行LC治疗，根据手术入路将患者分为胆囊前三角入路组和胆囊后三角入路组，每组90例。观察2组患者手术时间、术中出血量及术后肠功能恢复时间；2组患者分别于手术前及术后24 h采用BC5390型全自动血细胞分析仪进行白细胞（WBC）计数，酶联免疫吸附试验检测血清超敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）水平；观察2组患者术中转开腹手术及术后并发症发生情况。结果　2组胆囊粘连患者的手术时间、术后肠功能恢复时间长于无胆囊粘连患者，术中出血量大于无胆囊粘连患者（P<0.05）；2组无胆囊粘连患者的手术时间、术中出血量及术后肠功能恢复时间比较差异均无统计学意义（P>0.05）；胆囊后三角入路组胆囊粘连患者的手术时间、术后肠功能恢复时间短于胆囊前三角入路组胆囊粘连患者，术中出血量少于胆囊前三角入路组胆囊粘连患者（P<0.05）。2组患者术前WBC计数及血清hs-CRP和IL-6水平比较差异均无统计学意义（P>0.05）；术后24 h，2组胆囊粘连患者WBC计数及血清hs-CRP和IL-6水平均高于无胆囊粘连患者（P<0.05）；2组患者术后24 h WBC计数及血清hs-CRP和IL-6水平均高于术前（P<0.05）；术后24 h，2组无胆囊粘连患者WBC计数及血清hs-CRP和IL-6水平比较差异均无统计学意义（P>0.05），胆囊后三角入路组胆囊粘连患者WBC计数及血清hs-CRP和IL-6水平均低于胆囊前三角入路组胆囊粘连患者（P<0.05）。胆囊前三角入路组无胆囊粘连和胆囊粘连患者术后并发症发生率分别为6.67%（3/45）、17.78%（8/45）；胆囊前三角入路组胆囊粘连患者并发症发生率高于无胆囊粘连患者（χ²=2.107，P<0.05）。胆囊后三角入路组无胆囊粘连和胆囊粘连患者术后并发症发生率分别为2.22%（1/45）、6.67%（3/45）；胆囊后三角入路组无胆囊粘连患者与胆囊粘连患者并发症发生率比较差异无统计学意义（χ²=0.417，P>0.05）；2组无胆囊粘连患者并发症发生率比较差异无统计学意义（χ²=0.262，P>0.05）；胆囊后三角入路组胆囊粘连患者并发症发生率低于胆囊前三角入路组胆囊粘连患者（χ²=1.402，P<0.05）。胆囊前三角入路组胆囊粘连患者术中转开腹手术4例，2组其他患者均顺利完成腹腔镜手术。结论　对于无胆囊粘连的胆囊结石伴慢性胆囊炎患者，胆囊后三角入路与胆囊前三角入路LC的临床疗效相当；对于胆囊粘连的胆囊结石伴慢性胆囊炎患者，胆囊后三角入路LC的临床疗效优于胆囊前三角入路，且术中转开腹手术及并发症发生率低。

Abstract:

Objective　To compare the clinical effect of laparoscopic cholecystectomy (LC) through posterior and anterior triangle approaches of gallbladder in the treatment of cholecystolithiasis complicated with chronic cholecystitis.Methods　A total of 180 patients with cholecystolithiasis complicated with chronic cholecystitis admitted to the First People′s Hospital of Ruzhou from January 2017 to December 2018 were selected as the research subjects.All patients were treated with LC,and the patients were divided into the anterior triangular approach group and the posterior triangle approach group according to the surgical approach,with 90 cases in each group.The operation time,intraoperative bleeding volume and postoperative intestinal function recovery time of the patients in the two groups were observed.Before and 24 hours after the operation,the white blood cell (WBC) counts were detected by BC5390 automatic blood cell analyzer,the levels of serum high sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) were detected by enzyme linked immunosorbent assay.The conversion to open operation and postoperative complications of the patients in the two groups were observed.Results　Compared with the patients without gallbladder adhesion,the operation time,postoperative intestinal function recovery time were longer,and the intraoperative bleeding volume was more in the patients with gallbladder adhesion in the two groups (P<0.05).There was no significant difference in the operation time,intraoperative bleeding volume and postoperative intestinal function recovery time of the patients without gallbladder adhesion between the two groups (P>0.05).Compared with the anterior triangle approach group,the operation time,postoperative intestinal function recovery time was shorter,and the intraoperative bleeding volume was less in the patients with gallbladder adhesion in the posterior triangle approach group (P<0.05).There was no significant difference in the WBC count and serum hs-CRP and IL-6 levels between the two groups before operation (P>0.05).At 24 hours after operation,the WBC count,serum hs-CRP and IL-6 levels in the patients with gallbladder adhesion were higher than those in the patients without gallbladder adhesion in the two groups (P<0.05).The WBC count and serum hs-CRP and IL-6 levels at 24 hours after operation were higher than those before operation in the two groups (P<0.05).At 24 h after operation,there was no significant difference in the WBC count and serum hs-CRP and IL-6 levels in the patients without gallbladder adhesion between the two groups (P>0.05),and the WBC count and serum hs-CRP and IL-6 levels of patients with gallbladder adhesion in the posterior triangle approach group were lower than those in the anterior triangle approach group (P<0.05).In the anterior triangle approach group,the incidence of postoperative complications in the patients without gallbladder adhesion and the patients with gallbladder adhesion was 6.67% (3/45) and 17.78% (8/45),respectively;the incidence of complications in the patients with gallbladder adhesion was significantly higher than those in the patients without gallbladder adhesion (χ²　=2.107,P<0.05).In the posterior triangle approach group,the incidence of postoperative complications in the patients without gallbladder adhesion and the patients with gallbladder adhesion was 2.22% (1/45) and 6.67% (3/45),respectively;there was no significant difference in the incidence of complications between the patients without gallbladder adhesion and the patients with gallbladder adhesion (χ²　=0.417,P>0.05).There was no significant difference in the incidence of complications in the patients without gallbladder adhesion between the two groups (χ²　=0.262,P>0.05).The incidence of complications in the patients with gallbladder adhesion in the posterior triangle approach group was lower than that in the anterior triangle approach group (χ²　=1.402,P<0.05).Four cases were converted to open surgery in the anterior triangle approach group,and the laparoscopic operation of other patients in the two groups was successfully completed.Conclusion　For the cholecystolithiasis and chronic cholecystitis patients without gallbladder adhesion,the clinical effect of LC through posterior triangle approach and anterior triangle approach is similar.For the cholecystolithiasis and chronic cholecystitis patients with gallbladder adhesion,the clinical effect of LC through posterior triangle approach is better than that via anterior triangle approach,and the rate of conversion to open surgery and complications is low.

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更新日期/Last Update: 2020-06-05