几种不同腹腔镜胆囊切除术的临床疗效分析

摘要

目的：分析几种不同腹腔镜胆囊切除术（LC）的临床效果。方法选取北京市昌平区中医医院2013年1月－2014年9月行LC的患者400例，随机分为单孔法LC组、二孔法LC组、三孔法LC组、四孔法LC组各100例，通过术中出血量、手术时间、术后离床活动时间、术后进食时间、术后住院天数及术后6h疼痛程度6个指标进行系统的分析，比较4组之间的临床疗效。计量资料组间比较采用方差分析，计数资料采用χ2检验。结果组间比较时单孔法组的术后6 h疼痛程度与二孔法组比较差异有统计学意义[（2.7±0.4）分vs （1．9±0.8）分，P＝0.036]，单孔法手术时间与三孔法比较差异有统计学意义[（55．6±23.5）min vs （36．0±24．3）min，P＝0.028]，单孔法术后住院天数与三孔法比较差异有统计学意义[（3．0±2．3）d vs （5．2±3．3）d，P＝0.042]，其他指标组间比较差异均无统计学意义（P值均＞0．05）。4组患者均未出现严重并发症。结论4种方法都是安全可行的，但应规范操作技术，熟练解剖知识，严格掌握手术情况的变化，手术前还应根据患者的意愿及身体状况选择合适的手术方法，提高手术的安全性。%Objective To analyze the clinical effects of several different approaches to laparoscopic cholecystectomy.Methods A total of 400 patients who received cholecystectomy in our hospital from January 2013 to September 2014 were divided into four groups according to the approaches to laparoscopy (n=100 per group):single-port laparoscopic cholecystectomy,two-trocar laparoscopic cholecystectomy, three-trocar laparoscopic cholecystectomy,and four-trocar laparoscopic cholecystectomy.All clinical data were systematically analyzed on six indicators:blood loss during surgery,operation time,time to ambulation after surgery,time to taking meal after surgery,length of hospi-tal stay after surgery,and the degree of pain at 6 h after surgery (rating of pain scale).The clinical effects of the different approaches were compared between the four groups.Results Significant differences were observed in the following indicators:the degree of pain at 6 h after surgery between the groups of single-port and two-trocar laparoscopic cholecystectomy [(2.7 ±0.4 vs 1.9 ±0.8),P=0.036];operation time between the groups of single-port and three-trocar laparoscopic cholecystectomy [(55.6 ±23.5)min vs (36.0 ±24.3)min,P=0.028];length of hospital stay between the groups of single-port and three-trocar laparoscopic cholecystectomy [(3.0 ±2.3)d vs (5.2 ±3.3)d,P=0.042].All other indicators showed no significant differences between groups (P>0.05).Statistical analysis of the six in-dicators indicated that all four approaches did not significantly influence the incidence of surgical complications (P>0.05).Conclusion All the four approaches to laparoscopic cholecystectomy are safe and feasible,but the operation techniques should be standardized,anatomi-cal knowledge should be mastered,and any changes in the surgical situation should be strictly monitored.Before the surgery,the patients′wishes and their physical conditions should be considered to choose the appropriate surgical approach and improve the surgical safety.