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[摘要] 目的 探讨单孔法腹腔镜胆囊切除术治疗良性胆囊疾病的临床疗效和安全性。 方法 将80例进行胆囊切除术治疗的患者采用随机数字的方法分为观察组和对照组各40例,观察组采用单孔法,对照组采用三孔法,比较两组患者手术时间、术中出血量、术中副损伤、中转开腹、术后疼痛、术后下床活动时间、术后肠功能恢复时间、住院时间、术后并发症和对切口的满意度等。 结果 两组患者均未发生术中副损伤、术后并发症及中转开腹;两组在手术时间、术中出血量和术后住院时间方面比较,差异均无统计学意义(P>0.05);但是观察组患者术后疼痛程度、下床活动时间、肠功能恢复时间和对切口的满意度均优于对照组,差异有统计学意义(P<0.05)。 结论 单孔法腹腔镜胆囊切除术治疗良性胆囊疾病能最大程度地体现手术的微创、减轻疼痛,促进患者术后康复,满足患者对美的要求,安全性高,值得临床推广应用。
[关键词] 胆囊切除术;腹腔镜;单孔法;三孔法
[中图分类号] R657.4 [文献标识码] B [文章编号] 1673-9701(2016)21-0039-03
[Abstract] Objective To discuss the clinical efficacy and safety of single-hole laparoscopic cholecystectomy in treatment of benign gallbladder diseases. Methods A total of 80 patients were randomly and equally divided into observation group and control group, each of 40 cases. Patients in the observation group were given single-hole laparoscopy, and those in the control group were given three-hole laparoscopy. The operation duration, blood loss, side injury, conversion to laparotomy, postoperation pain, time to leave bed, recovery time of bowel movement, hospital stay, postoperative complications, and satisfaction towards incision were compared between two groups. Results No side injury, conversion to laparotomy, and postoperative complication was observed in two groups. There were no significant differences in operation duration, blood loss, and hospital stay between two groups(P>0.05). The postoperation pain, time to leave bed, recovery time of bowel movement, and satisfaction towards incision in the observation group were significantly superior to those in the control group (P<0.05). Conclusion Application of single-hole laparoscopic cholecystectomy in treatment of benign gallbladder diseases can maximize the advantages of minimal invasiveness, pain alleviation, and promotion of postoperative rehabilitation, with high satisfaction and safety, thus is worthy to be promoted.
[Key words] Cholecystectomy; Laparoscopy; Single-hole method; Three holes method
自1987年法国人Mourettx首次采取腹腔镜辅助实施胆囊切除术治疗胆囊疾病后,随着技术的不断更新与进步,已经实现了对良性胆囊疾病的金标准手术治疗形式。因为其具有创伤小、恢复快、患者自身痛苦小以及费用低等诸多临床优势,因此在临床治疗中得到了迅速的普及与推广,成为治疗良性胆囊疾病的不二术式[1,2]。近年来,随着临床腹腔镜技术的不断发展和进步,为了逐步实现患者对于伤口美观的要求,腹腔镜手术逐渐由四孔缩减为了单孔,确保了手术的微创,术后对患者创伤更小,术后痕迹更加美观[3]。2009年11月~2011年11月期间,我院应用单孔腹腔镜胆囊切除术对患者的良性胆囊疾病进行治疗,效果满意,现报道如下。
1 资料与方法
1.1 一般资料
经医院医学伦理学委员会批准,收集在我院进行胆囊切除术治疗的患者80例,其中男28例、女52例,年龄34~76岁。类型:胆囊息肉30例、胆囊结石39例和胆囊结石并息肉11例。体征:绝大部分患者均表现为右上腹压痛并向右肩背部放射、Murphy征阳性和肌紧张;胆囊息肉患者基本无特殊临床症状,为常规体检发现。血常规:部分患者存在白细胞或中性粒细胞计数升高。同时超声检查可以发现,患者均存在胆囊增大、胆囊结石壁增厚等情况。所有患者均无手术禁忌以及腹部术史,无严重炎症以肝肾功能障碍。80例患者中,采取择期手术69例,采取紧急手术治疗11例。患者均同意进入本研究,签署知情同意书,采用随机数字法,将80例患者分为观察组和对照组,各40例,两组一般资料差异无统计学意义(P>0.05),具有可比性。见表1。 [参考文献]
[1] 仇根存,祁怀玉,赵建华,等. 腹腔镜胆囊切除术的并发症及预防[J]. 中国现代医生,2010,48(26):126.
[2] 于晓鹏,吴硕东,于宏,等. 腹腔镜联合胆囊镜两孔法保胆息肉摘除术40例[J]. 中国现代普通外科进展,2015, 18(1):26-29.
[3] 张文正,梁鲁,姚碧辉. 单孔腹腔镜胆囊切除术的临床现状及隐忧[J]. 中国微创外科杂志,2015,15(4):366-367.
[4] 周斌,蒋志龙,耿忠泽,等. 经脐单孔腹腔镜胆囊切除术可行性分析(附48例报告)[J]. 山东大学学报(医学版),2011,49(11):105-107.
[5] Baird JF,Kiyak HA. The uninformed orthodontic patient and parent:treatment outcomes[J]. Am J Orthod Dentofacial Orthop,2003,124(2):212-215.
[6] 郭伟,张忠涛,韩威,等. 经脐单孔腹腔镜胆囊切除术[J]. 腹腔镜外科杂志,2009,1(14):24-26.
[7] 黄海,钱伟峰,高源,等. “悬吊式”经脐单孔腹腔镜胆囊切除12例分析[J]. 实用临床医药杂志,2014,18(17):87.
[8] 陈伯泉,肖超. 腹腔镜与开腹手术治疗慢性胆囊炎胆囊结石的临床疗效分析[J]. 吉林医学,2016,37(4):937-938.
[9] 何涛,潘杰,董嘉天,等. 经脐单孔腹腔镜胆囊切除术44例分析[J]. 实用医学杂志,2013,29(8):1305-1307.
[10] 李成林. 经脐单孔腹腔镜胆囊切除术对患者血管内皮功能和炎症因子的影响[J]. 海南医学院学报,2016,22(7):673-676.
[11] 周志涛,毛常青,吕培标,等. 单孔腹腔镜经脐胆囊切除术60例临床观察[J]. 海南医学,2013,24(4):352-354.
[12] 杨福,何建平,李晓凯. 经脐部单孔腹腔镜胆囊切除术及常规腹腔镜胆囊切除术的疗效比较[J]. 肝胆胰外科杂志,2015,27(6):523-525.
[13] 陶涛,吴乔松,朱春远,等. 经脐单孔腹腔镜胆囊切除术35例报告[J]. 现代临床医学,2011,37(5):357-358.
[14] 吴志明,储修峰,娄建平,等. 经脐单孔腹腔镜胆囊切除术的临床推广探讨[J]. 中华腔镜外科杂志(电子版),2011,4(3):217-220.
[15] 张启林,吴强,杨晓春,等. 经脐单孔法腹腔镜胆囊切除术的临床研究[J]. 肝胆外科杂志,2011,19(4):292-293.
(收稿日期:2016-05-20)
[关键词] 胆囊切除术;腹腔镜;单孔法;三孔法
[中图分类号] R657.4 [文献标识码] B [文章编号] 1673-9701(2016)21-0039-03
[Abstract] Objective To discuss the clinical efficacy and safety of single-hole laparoscopic cholecystectomy in treatment of benign gallbladder diseases. Methods A total of 80 patients were randomly and equally divided into observation group and control group, each of 40 cases. Patients in the observation group were given single-hole laparoscopy, and those in the control group were given three-hole laparoscopy. The operation duration, blood loss, side injury, conversion to laparotomy, postoperation pain, time to leave bed, recovery time of bowel movement, hospital stay, postoperative complications, and satisfaction towards incision were compared between two groups. Results No side injury, conversion to laparotomy, and postoperative complication was observed in two groups. There were no significant differences in operation duration, blood loss, and hospital stay between two groups(P>0.05). The postoperation pain, time to leave bed, recovery time of bowel movement, and satisfaction towards incision in the observation group were significantly superior to those in the control group (P<0.05). Conclusion Application of single-hole laparoscopic cholecystectomy in treatment of benign gallbladder diseases can maximize the advantages of minimal invasiveness, pain alleviation, and promotion of postoperative rehabilitation, with high satisfaction and safety, thus is worthy to be promoted.
[Key words] Cholecystectomy; Laparoscopy; Single-hole method; Three holes method
自1987年法国人Mourettx首次采取腹腔镜辅助实施胆囊切除术治疗胆囊疾病后,随着技术的不断更新与进步,已经实现了对良性胆囊疾病的金标准手术治疗形式。因为其具有创伤小、恢复快、患者自身痛苦小以及费用低等诸多临床优势,因此在临床治疗中得到了迅速的普及与推广,成为治疗良性胆囊疾病的不二术式[1,2]。近年来,随着临床腹腔镜技术的不断发展和进步,为了逐步实现患者对于伤口美观的要求,腹腔镜手术逐渐由四孔缩减为了单孔,确保了手术的微创,术后对患者创伤更小,术后痕迹更加美观[3]。2009年11月~2011年11月期间,我院应用单孔腹腔镜胆囊切除术对患者的良性胆囊疾病进行治疗,效果满意,现报道如下。
1 资料与方法
1.1 一般资料
经医院医学伦理学委员会批准,收集在我院进行胆囊切除术治疗的患者80例,其中男28例、女52例,年龄34~76岁。类型:胆囊息肉30例、胆囊结石39例和胆囊结石并息肉11例。体征:绝大部分患者均表现为右上腹压痛并向右肩背部放射、Murphy征阳性和肌紧张;胆囊息肉患者基本无特殊临床症状,为常规体检发现。血常规:部分患者存在白细胞或中性粒细胞计数升高。同时超声检查可以发现,患者均存在胆囊增大、胆囊结石壁增厚等情况。所有患者均无手术禁忌以及腹部术史,无严重炎症以肝肾功能障碍。80例患者中,采取择期手术69例,采取紧急手术治疗11例。患者均同意进入本研究,签署知情同意书,采用随机数字法,将80例患者分为观察组和对照组,各40例,两组一般资料差异无统计学意义(P>0.05),具有可比性。见表1。 [参考文献]
[1] 仇根存,祁怀玉,赵建华,等. 腹腔镜胆囊切除术的并发症及预防[J]. 中国现代医生,2010,48(26):126.
[2] 于晓鹏,吴硕东,于宏,等. 腹腔镜联合胆囊镜两孔法保胆息肉摘除术40例[J]. 中国现代普通外科进展,2015, 18(1):26-29.
[3] 张文正,梁鲁,姚碧辉. 单孔腹腔镜胆囊切除术的临床现状及隐忧[J]. 中国微创外科杂志,2015,15(4):366-367.
[4] 周斌,蒋志龙,耿忠泽,等. 经脐单孔腹腔镜胆囊切除术可行性分析(附48例报告)[J]. 山东大学学报(医学版),2011,49(11):105-107.
[5] Baird JF,Kiyak HA. The uninformed orthodontic patient and parent:treatment outcomes[J]. Am J Orthod Dentofacial Orthop,2003,124(2):212-215.
[6] 郭伟,张忠涛,韩威,等. 经脐单孔腹腔镜胆囊切除术[J]. 腹腔镜外科杂志,2009,1(14):24-26.
[7] 黄海,钱伟峰,高源,等. “悬吊式”经脐单孔腹腔镜胆囊切除12例分析[J]. 实用临床医药杂志,2014,18(17):87.
[8] 陈伯泉,肖超. 腹腔镜与开腹手术治疗慢性胆囊炎胆囊结石的临床疗效分析[J]. 吉林医学,2016,37(4):937-938.
[9] 何涛,潘杰,董嘉天,等. 经脐单孔腹腔镜胆囊切除术44例分析[J]. 实用医学杂志,2013,29(8):1305-1307.
[10] 李成林. 经脐单孔腹腔镜胆囊切除术对患者血管内皮功能和炎症因子的影响[J]. 海南医学院学报,2016,22(7):673-676.
[11] 周志涛,毛常青,吕培标,等. 单孔腹腔镜经脐胆囊切除术60例临床观察[J]. 海南医学,2013,24(4):352-354.
[12] 杨福,何建平,李晓凯. 经脐部单孔腹腔镜胆囊切除术及常规腹腔镜胆囊切除术的疗效比较[J]. 肝胆胰外科杂志,2015,27(6):523-525.
[13] 陶涛,吴乔松,朱春远,等. 经脐单孔腹腔镜胆囊切除术35例报告[J]. 现代临床医学,2011,37(5):357-358.
[14] 吴志明,储修峰,娄建平,等. 经脐单孔腹腔镜胆囊切除术的临床推广探讨[J]. 中华腔镜外科杂志(电子版),2011,4(3):217-220.
[15] 张启林,吴强,杨晓春,等. 经脐单孔法腹腔镜胆囊切除术的临床研究[J]. 肝胆外科杂志,2011,19(4):292-293.
(收稿日期:2016-05-20)