摘要
目的比较胆囊颈部切开与横断在胆囊颈部结石嵌顿中的腹腔镜胆囊切除手术效果。方法回顾性分析绍兴市中心医院2014年1月至2020年6月收治的194例胆囊颈部结石嵌顿行腹腔镜胆囊切除术的患者病例资料,手术分别采用胆囊颈部横断(A组,n=91)和胆囊颈部切开(B组,n=103)两种方法,比较两组手术时间、术中出血及中转开腹、术后住院时间、术后并发症等情况。结果与A组比较,B组手术时间更短[(59.0±15.4)min vs(65.5±24.4)min,t=2.248,P=0.026],术中出血更少[53(51.3,55.3)mL vs 35(33.4,37.3)mL,Z=2.114,P=0.036],中转开腹率更低(3.9%vs 15.4%,P=0.007),术后总并发症更少(4.9%vs 17.6%,P=0.005),术后住院时间更短[8.6(6.6,10.5)d vs 6.0(4.0,8.0)d,Z=2.759,P=0.006],差异均有统计学意义(P<0.05);但两组在术后腹腔感染(1.9%vs 7.7%)、术后出血(1.0%vs 3.3%)、胆漏(1.0%vs 2.2%)、结石残留(1.0%vs 3.3%)等并发症方面差异无统计学意义(P>0.05)。结论对胆囊颈部结石嵌顿行腹腔镜胆囊切除术,颈部切开相比胆囊颈部横断更有助于手术的实施。
Objective To compare the effect of laparoscopic cholecystectomy(LC)with neck incision and transection in treatment of incarcerated gallstones in the neck of gallbladder.Methods A total of 194 cases who underwent LC in Shaoxing Central Hospital between Jan.2014 and Jun.2020 were retrospectively analyzed.Patients were divided into neck transection group(Group A,n=91)and neck incision group(Group B,n=103)according to given operation methods.The operation time,intraoperative bleeding,conversion to laparotomy,postoperative hospitalization time,postoperative complications were compared between two groups.Results Compared with group A,group B had shorter operation time[(59.0±15.4)min vs(65.5±24.4)min,t=2.248,P=0.026],less intraoperative bleeding[53(51.3,55.3)mL vs 35(33.4,37.3)mL,Z=2.114,P=0.036],lower conversion rate to laparotomy(3.9%vs 15.4%,P=0.007),less postoperative complications(4.9%vs 17.6%,P=0.005),and shorter postoperative hospitalization time[8.6(6.6,10.5)d vs 6.0(4.0,8.0)d,Z=2.759,P=0.006].However,there was no significant difference in postoperative abdominal infection(1.9%vs 7.7%),postoperative bleeding(1.0%vs 3.3%),postoperative bile leakage(1.0%vs 2.2%)and residual stonesincidence(1.0%vs 3.3%)between two groups(P>0.05).Conclusion For patients with incarcerated gallstones in the neck of gallbladder,neck incision is more conducive to the implementation of laparoscopic cholecystectomy than neck transection.
作者
黄洪军
吴志明
孟兴成
张举
黄志强
王一帆
HUANG Hong-jun;WU Zhi-ming;MENG Xing-cheng;ZHANG Ju;HUANG Zhi-qiang;WANG Yi-fan(Department of General Surgery,Shaoxing Central Hospital,Shaoxing,Zhejiang 312030,China;Department of General Surgery,Sir Run Run Shaw Hospital,College of Medicine,Zhejiang University,Hangzhou 310016,China)
出处
《肝胆胰外科杂志》
CAS
2021年第6期352-355,共4页
Journal of Hepatopancreatobiliary Surgery
关键词
腹腔镜胆囊切除术
结石嵌顿
手术技巧
laparoscopic cholecystectomy
calculi incarceration
surgical techniques
