目的

探究不同路径腹腔镜胆囊切除术（LC）治疗急性胆囊炎的近中期疗效。

方法

回顾性分析2022年1月至2024年1月150例接受LC治疗的急性胆囊炎患者临床资料，根据手术路径不同分为改良组与传统组，传统组行常规顺行性切除方法（n=75例），改良组行循“A-B-D”路径切除（n=75例）。采用SPSS 27.0统计学软件处理数据，围手术期各项指标等计量资料采用（±s）表述，行独立样本t检验；术后并发症、中转开腹率等计数资料［例（%）］表述，采用χ²检验。P＜0.05为差异有统计学意义。

结果

改良组患者中转开腹率、术中胆管损伤率分别为（2.7%、2.7%）明显低于传统组（12.0%、13.3%）（P＜0.05）；两组患者腹腔感染、胆瘘以及出血发生率比较差异无统计学意义（P＞0.05）；改良组患者残余结石伴胆囊炎发生率（2.7%）明显低于传统组（13.3%）（P＜0.05）。

结论

相较于常规顺行性切除，循“A-B-D”路径能有效降低LC患者胆管损伤率、中转开腹率与残余结石伴胆囊炎发生率。

Objective

To explore the short-and medium-term efficacy of laparoscopic cholecystectomy （LC） via different approaches in the treatment of acute cholecystitis.

Methods

The clinical data of 150 patients with acute cholecystitis who underwent LC treatment from January 2022 to January 2024 were retrospectively analyzed.According to different surgical approaches，they were divided into the modified group and the traditional group.The traditional group underwent routine antegrade resection （n=75 cases），and the modified group underwent resection along the “A-B-D” approach （n=75 cases）.The statistical software SPSS 27.0 was used to process the data.Measurement data such as various perioperative indexes were expressed as （±s），and the independent sample t test was performed.Count data such as postoperative complications and the conversion rate to open surgery were expressed as［ cases （%）］，and the χ² test was used.A P value less than 0.05 was considered to indicate a statistically significant difference.

Results

The conversion rate to open surgery and the intraoperative bile duct injury rate in the modified group were （2.7%，2.7%） respectively，which were significantly lower than those in the traditional group （12.0%，13.3%） （P＜0.05）.There was no statistically significant difference in the incidence of abdominal cavity infection，bile leakage and bleeding between the two groups （P＞0.05）.The incidence of residual stones accompanied by cholecystitis in the modified group （2.7%） was significantly lower than that in the traditional group （13.3%） （P＜0.05）.

Conclusion

Compared with the routine antegrade resection，resection along the “A-B-D” approach can effectively reduce the bile duct injury rate，the conversion rate to open surgery and the incidence of residual stones accompanied by cholecystitis in LC patients.