丝线结扎法在腹腔镜胆囊切除术胆囊管处理中的临床应用研究
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摘要
目的探讨普通丝线结扎法在腹腔镜胆囊切除术胆囊管离断过程中的安全性及有效性。方法选取2017年6月至2018年6月在我科住院行腹腔镜胆囊切除术的120例胆囊结石和/或胆囊息肉患者,随机等分为两组,其中60例行7#丝线结扎法处理胆囊管,另60例行Hem-O-Lok夹法处理胆囊管。术后均予以常规治疗,比较两组术后有无差异。结果两组患者均顺利施术,术中未发生胆管损伤,术后无胆瘘、出血、腹腔感染等并发症发生,其中丝线结扎组术后未发生线结松动或脱落严重并发症。此外,丝线结扎组患者平均住院费用显著低于Hem-O-Lok夹组(P<0.05),但两组平均手术时间、术中出血、术后胆漏、术后引流管拔除时间、术后胃排空延迟指标,差异均无统计学意义(P>0.05)。而对于胆囊管较粗者,丝线结扎较Hem-O-Lok夹更为牢靠。结论丝线结扎法处理胆囊管在腹腔镜胆囊切除术中安全可行,可有效降低患者住院费用,尤其适用于胆囊管较粗患者。
Objective To investigate the safety and efficacy of common silk thread ligation in laparoscopic cholecystectomy with cystic duct detachment. Methods 120 patients with cholecystolithiasis and/or gallbladder polyps underwent laparoscopic cholecystectomy were selected from June 2017 to June 2018, and divided into two groups randomly, among which 60 cases were treated with 7# silk ligation to dissect cystic duct, and 60 cases were treated by Hem-O-Lok clamp. All patients were given conventional treatment after operation, and the difference was compared between the two groups after operation. Results All patients of two groups were all successfully operated, no bile duct injury occurred during the operation and no complications such as biliary fistula, hemorrhage, abdominal infection occurred after the operation, there was no complication of loosening or falling off after operation in silk ligation group. In addition, the average cost of hospitalization in the silk ligation group was significantly lower than that in the Hem-O-Lok clamp group(P<0.05), however, there were no significant differences in the mean operation time, intraoperative bleeding, bile leakage, drainage tube removal time and delayed gastric emptying between the two groups(P>0.05). Moreover, for the thicker cystic duct, silk ligation was more reliable than that of Hem-O-Lok clip. Conclusion Ligation of cystic duct with silk thread is safe and feasible in laparoscopic cholecystectomy, which can effectively reduce the hospitalization costs of patients, and especially suitable for patients with thick cystic duct.
Objective To investigate the safety and efficacy of common silk thread ligation in laparoscopic cholecystectomy with cystic duct detachment. Methods 120 patients with cholecystolithiasis and/or gallbladder polyps underwent laparoscopic cholecystectomy were selected from June 2017 to June 2018, and divided into two groups randomly, among which 60 cases were treated with 7# silk ligation to dissect cystic duct, and 60 cases were treated by Hem-O-Lok clamp. All patients were given conventional treatment after operation, and the difference was compared between the two groups after operation. Results All patients of two groups were all successfully operated, no bile duct injury occurred during the operation and no complications such as biliary fistula, hemorrhage, abdominal infection occurred after the operation, there was no complication of loosening or falling off after operation in silk ligation group. In addition, the average cost of hospitalization in the silk ligation group was significantly lower than that in the Hem-O-Lok clamp group(P<0.05), however, there were no significant differences in the mean operation time, intraoperative bleeding, bile leakage, drainage tube removal time and delayed gastric emptying between the two groups(P>0.05). Moreover, for the thicker cystic duct, silk ligation was more reliable than that of Hem-O-Lok clip. Conclusion Ligation of cystic duct with silk thread is safe and feasible in laparoscopic cholecystectomy, which can effectively reduce the hospitalization costs of patients, and especially suitable for patients with thick cystic duct.
引文
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[11] 金鑫,冯利,赵国海,等.腹腔镜胆囊切除术并发症发生率及其影响因素[J].中国普通外科杂志,2013,22:(8):1053-1056.
[12] 陈占斌,贾琪,刘金虎,等.胆囊管结扎夹闭法在腹腔镜胆囊切除术中处理粗大胆囊管的应用体会(附104例报告)[J].中国微创外科杂志,2012,12(11):1051-1052.
[13] 邱应福.腹腔镜胆囊切除术中增粗胆囊管处理方法的探讨[J].腹腔镜外科杂志,2007,12 (3):249-250.
[14] Pang L,Yuan J,Zhang Y,et al.Clip-stone and T clip-sinus:a clinical analysis of six cases on migration of clips and literature review from 1997 to 2017[J].J Minim Access Surg,2018,3(5):24-28.
[2] 甄永强,徐文样,张丽华,等.双镜联合微创保胆取石术与腹腔镜胆囊切除术的临床对比研究[J].中华普外科手术学杂志(电子版),2018,12(1):85-87.
[3] 陈建中,梁光彩,成正军,等.腹腔镜胆囊切除术中胆囊管结石的诊治策略[J].腹腔镜外科杂志,2018,23(6):444-447.
[4] 顾炜,蔡兵,吴鸣宇.Hem-O-Lok夹和可吸收夹在腹腔镜胆囊切除术中的临床应用比较[J].肝胆胰外科杂志,2018,27(3):238-240.
[5] 李昆仑,陈昕,李博,等.腹腔镜胆囊切除术中Hem-O-Lok夹常规处理胆囊管及胆囊动脉的临床研究[J].中国医学创新,2016,13(4):55-57.
[6] Qu JW,Wang GY,Yuan ZQ,et al.Hem-o-lock clips migration:an easily neglected complication after laparoscopic biliary surgey[J].Case Rep Sueg,2017,9(2):21-15.
[7] 李向文,闫军.经脐单孔腹腔镜胆囊切除术现状研究[J].中国药物与临床,2018,18(1):58-59.
[8] Koichev A.Comparative analysis of four-port and the three-port trocar access and the single port access in laparoscopic cholecystectomy-review of the literature[J].Khirurgiia,2014,14(4):47-56.
[9] 周红兵,杨兴业,陈曦,等.腹腔镜下胆囊动脉入路精细解剖胆囊三角的临床价值[J].中国普通外科杂志,2015,24(8):1121-1124.
[10] Liu Y,Ji B,Wang Y,et al.Hem-O-Lok clip found in common bile duct after laparoscopic cholecystectomy and common bile duct exploration:a clinical analysis of 8 cases[J].Int J Med Sci,2012,9(3):225-227.
[11] 金鑫,冯利,赵国海,等.腹腔镜胆囊切除术并发症发生率及其影响因素[J].中国普通外科杂志,2013,22:(8):1053-1056.
[12] 陈占斌,贾琪,刘金虎,等.胆囊管结扎夹闭法在腹腔镜胆囊切除术中处理粗大胆囊管的应用体会(附104例报告)[J].中国微创外科杂志,2012,12(11):1051-1052.
[13] 邱应福.腹腔镜胆囊切除术中增粗胆囊管处理方法的探讨[J].腹腔镜外科杂志,2007,12 (3):249-250.
[14] Pang L,Yuan J,Zhang Y,et al.Clip-stone and T clip-sinus:a clinical analysis of six cases on migration of clips and literature review from 1997 to 2017[J].J Minim Access Surg,2018,3(5):24-28.
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