不分离离断胆囊动脉主干的腹腔镜胆囊切除术在急性结石性胆囊炎治疗中的应用(1)
[摘要]目的 探讨不分离离断胆囊动脉主干的腹腔镜胆囊切除术用于治疗急性结石性胆囊炎的安全性及临床效果。方法 选取2015年10月～2017年3月在我院因急性结石性胆囊炎行腹腔镜胆囊切除术的84例患者的临床资料，包括年龄、性别、手术时间、术中出血量、术后住院时间及术后并发症发生情况。观察组42例患者实施了不分离离断胆囊动脉主干的腹腔镜胆囊切除术，对照组42例患者行常规腹腔镜胆囊切除术。结果 两组患者均顺利完成手术，无中转开腹。两组患者在年龄、性别、手术时间、术后住院时间等方面差异无统计学意义(P>0.05)，观察组术中出血量较对照组明显减少(t=4.75，P<0.05)，观察组术后并发症总发生率明显少于对照组(t=7.26，P<0.05)。结论 不分离离断胆囊动脉主干的腹腔镜胆囊切除术用于治疗急性结石性胆囊炎可有效减少术中、术后出血及术后并发症的发生，值得临床推广使用。
[关键词]急性胆囊炎；胆囊动脉主干；腹腔镜；胆囊切除
[中图分类号] R657.4 [文献标识码] A [文章编号] 1674-4721(2017)10(a)-0018-03
[Abstract]Objective To investigate the safety and clinical efficacy of laparoscopic cholecystectomy using the technique of non-separation and non-disconnection of the trunk of the cystic artery in the treatment of acute calculous cholecystitis.Methods From October 2015 to March 2017，the clinical data of 84 patients undergone laparoscopic cholecystectomy due to acute calculous cholecystitis in our hospital were retrospectively analyzed.The age，sex，operation time，intraoperative amount of bleeding，hospital stay after surgery，and occurrence of postoperative complications were extracted.In observation group (n=42)，laparoscopic cholecystectomy using the technique of non-separation and non-disconnection of the trunk of the cystic artery was adopted，while in the control group(n=42)，regular laparoscopic cholecystectomy was used.Results Patients in the two groups were all successfully finished the operation without transfering to laparotomy.There was no significant difference in age，sex，operation time，or hospital stay after surgery between the two groups (P>0.05).The bleeding during surgery in the observation group was less compared with that in the control group (t=4.75，P<0.05).The total incidence of postoperative complications was significantly lower in the observation group in comparison with that in the control group (t=7.26，P<0.05).Conclusion Application of laparoscopic cholecystectomy using the technique of non-separation and non-disconnection of the trunk of the cystic artery to treat acute calculous cholecystitis can effectively reduce the occurrence of bleeding during and after surgery as well as postoperative complications，which is worthy of promotion in clinic.
[Key words]Acute cholecystitis；Trunk of cystic artery；Laparoscope；Cholecystectomy
膽囊结石是临床上肝胆外科的常见病及多发病，而治疗胆囊结石的方法为胆囊切除术，腹腔镜胆囊切除术(Laparoscopic Cholecystectomy，LC)以其创伤小、痛苦少、术后恢复快等优点，已成为胆囊切除的金标准[1]。LC术中关键且难度最大的一步就是对胆囊三角区的处理，尤其是对胆囊动脉的处理，目前临床上常规对胆囊动脉主干进行分离、结扎、离断。结石性胆囊炎急性发作时胆囊三角水肿导致局部解剖结构不清，如盲目分离胆囊动脉，有可能损伤胆囊动脉及胆管，造成出血及胆漏等严重并发症，同时术后水肿消退后，可能会出现生物夹松动甚至脱落导致术后大出血。近年来，腹腔镜设备的升级以及临床医生手术技术的成熟，同时传统观念有所改变，国内外学者[2-3]报道了不分离离断胆囊动脉主干的LC，临床疗效安全可靠。本文比较不分离离断胆囊动脉主干的LC和常规LC治疗急性结石性胆囊炎的临床效果，探讨其安全性及临床效果，现报道如下。, 百拇医药(李正臣 刘养岁 张昕辉)
[关键词]急性胆囊炎；胆囊动脉主干；腹腔镜；胆囊切除
[中图分类号] R657.4 [文献标识码] A [文章编号] 1674-4721(2017)10(a)-0018-03
[Abstract]Objective To investigate the safety and clinical efficacy of laparoscopic cholecystectomy using the technique of non-separation and non-disconnection of the trunk of the cystic artery in the treatment of acute calculous cholecystitis.Methods From October 2015 to March 2017，the clinical data of 84 patients undergone laparoscopic cholecystectomy due to acute calculous cholecystitis in our hospital were retrospectively analyzed.The age，sex，operation time，intraoperative amount of bleeding，hospital stay after surgery，and occurrence of postoperative complications were extracted.In observation group (n=42)，laparoscopic cholecystectomy using the technique of non-separation and non-disconnection of the trunk of the cystic artery was adopted，while in the control group(n=42)，regular laparoscopic cholecystectomy was used.Results Patients in the two groups were all successfully finished the operation without transfering to laparotomy.There was no significant difference in age，sex，operation time，or hospital stay after surgery between the two groups (P>0.05).The bleeding during surgery in the observation group was less compared with that in the control group (t=4.75，P<0.05).The total incidence of postoperative complications was significantly lower in the observation group in comparison with that in the control group (t=7.26，P<0.05).Conclusion Application of laparoscopic cholecystectomy using the technique of non-separation and non-disconnection of the trunk of the cystic artery to treat acute calculous cholecystitis can effectively reduce the occurrence of bleeding during and after surgery as well as postoperative complications，which is worthy of promotion in clinic.
[Key words]Acute cholecystitis；Trunk of cystic artery；Laparoscope；Cholecystectomy
膽囊结石是临床上肝胆外科的常见病及多发病，而治疗胆囊结石的方法为胆囊切除术，腹腔镜胆囊切除术(Laparoscopic Cholecystectomy，LC)以其创伤小、痛苦少、术后恢复快等优点，已成为胆囊切除的金标准[1]。LC术中关键且难度最大的一步就是对胆囊三角区的处理，尤其是对胆囊动脉的处理，目前临床上常规对胆囊动脉主干进行分离、结扎、离断。结石性胆囊炎急性发作时胆囊三角水肿导致局部解剖结构不清，如盲目分离胆囊动脉，有可能损伤胆囊动脉及胆管，造成出血及胆漏等严重并发症，同时术后水肿消退后，可能会出现生物夹松动甚至脱落导致术后大出血。近年来，腹腔镜设备的升级以及临床医生手术技术的成熟，同时传统观念有所改变，国内外学者[2-3]报道了不分离离断胆囊动脉主干的LC，临床疗效安全可靠。本文比较不分离离断胆囊动脉主干的LC和常规LC治疗急性结石性胆囊炎的临床效果，探讨其安全性及临床效果，现报道如下。, 百拇医药(李正臣 刘养岁 张昕辉)