切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2025, Vol. 19 ›› Issue (04) : 388 -391. doi: 10.3877/cma.j.issn.1674-3946.2025.04.011.

论著

不同腹腔镜胆囊切除术治疗胆囊结石的疗效比较研究
李盼1, 张华秦2,()   
  1. 1. 716000 陕西延安,延安市人民医院普外二病区
    2. 716000 陕西延安,延安市人民医院普外科一病区
  • 收稿日期:2024-12-17 出版日期:2025-08-26
  • 通信作者: 张华秦
  • 基金资助:
    陕西省科学技术厅关于下达陕西省2022年科技计划项目(2022JM-583)

A comparative study on the efficacy of different laparoscopic cholecystectomies in the treatment of gallstone disease

Pan Li1, Huaqin Zhang2,()   

  1. 1. Second Ward of General Surgery, Yan’an People’s Hospital, Yan’an Shaanxi Province 716000, China
    2. First Ward of General Surgery, Yan’an People’s Hospital, Yan’an Shaanxi Province 716000, China
  • Received:2024-12-17 Published:2025-08-26
  • Corresponding author: Huaqin Zhang
引用本文:

李盼, 张华秦. 不同腹腔镜胆囊切除术治疗胆囊结石的疗效比较研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 388-391.

Pan Li, Huaqin Zhang. A comparative study on the efficacy of different laparoscopic cholecystectomies in the treatment of gallstone disease[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(04): 388-391.

目的

探讨不同腹腔镜胆囊切除术(LC)治疗胆囊结石的临床效果。

方法

回顾性选取2023年2月至2023年7月行LC的486例胆囊结石患者,根据不同手术方式分为三孔组(n=255例,采取三孔法LC)和两孔组(n=231例,采取两孔法LC)。采用SPSS 25.0统计学软件分析数据,计数资料用[例(%)]表示,行χ2检验;计量资料用()表示,组间比较采用独立样本t检验。P<0.05为差异有统计学意义。

结果

与三孔组相比,两孔组患者术中出血量更少,手术时间更长,术后排气时间、住院时间更短;两组患者术后24h和48h视觉模拟评分法(VAS)评分均低于术后6h(P<0.05),且与三孔组比较,两孔组术后6h、24h和48h的VAS评分更低(P<0.05);三孔组与两孔组患者术中中转开腹手术发生率、术后并发症发生率无明显差异(P>0.05);随访6个月,两组患者总胆红素(TBIL)、谷丙转氨酶(ALT)较术后即刻无明显差异,且组间对比均无明显差异(P>0.05);两组患者预后良好。

结论

两孔法、三孔法LC均能达到胆囊结石手术根治的要求,但两孔法LC具有出血量少、术后恢复快等优势,且因创伤性更小而疼痛程度更轻,两者具有相似的并发症发生率,预后均良好。

Objective

To explore the clinical efficacy of different laparoscopic cholecystectomies (LC)in the treatment of gallstone disease.

Methods

A total of 486 patients with gallstone disease who underwent LC from February 2023 to July 2023 were retrospectively selected. According to different surgical methods,they were divided into the three-port group (n=255, receiving three-port LC) and the two-port group (n=231,receiving two-port LC). The SPSS 25.0 statistical software was used to analyze the data. Enumeration data were expressed as[ cases (%)], and χ2 tests were performed; Measurement data were expressed as (), and independent sample t tests were used for comparison between groups. P<0.05 was considered to indicate a statistically significant difference.

Results

Compared with the three-port group, the patients in the two-port group had less intraoperative blood loss, a longer operation time, and shorter postoperative exhaust time and hospital stay. The Visual Analogue Scale (VAS) scores of the patients in both groups at 24 hours and 48 hours after the operation were lower than those at 6 hours after the operation (P<0.05). Moreover, compared with the three-port group, the VAS scores of the two-port group at 6 hours, 24 hours, and 48 hours after the operation were lower (P<0.05). There were no significant differences in the incidence of intraoperative conversion to open surgery and the incidence of postoperative complications between the three-port group and the two-port group (P>0.05). After a 6-month follow-up, there were no significant differences in the levels of total bilirubin(TBIL) and alanine aminotransferase (ALT) between the two groups compared with those immediately after the operation, and there were no significant differences between the groups (P>0.05). The prognosis of the patients in both groups was good.

Conclusion

Both the two-port and three-port LC can meet the requirements for the radical surgery of gallstone disease. However, the two-port LC has the advantages of less blood loss and faster postoperative recovery, and causes less pain due to its smaller invasiveness. The two methods have similar incidences of complications and both have a good prognosis.

表1 两组胆囊结石行LC患者一般资料对比
表2 两组胆囊结石行LC患者围手术期指标对比
表3 两组胆囊结石行LC患者术后疼痛程度对比(分,
表4 两组胆囊结石行LC患者肝功能指标对比(
[1]
Alemi F, Seiser N, Ayloo S. Gallstone Disease: Cholecystitis,Mirizzi Syndrome, Bouveret Syndrome, Gallstone Ileus[J]. Surg Clin North Am, 2019, 99(2): 231-244.
[2]
黄庆勇,牛彦锋,陈怡发,等. “三镜”联合在胆囊结石伴肝外胆管结石中的应用价值[J/CD]. 中华普外科手术学杂志(电子版),2020, 14(03): 303-305.
[3]
Portincasa P, Di Ciaula A, Bonfrate L, et al. Metabolic dysfunction-associated gallstone disease: expecting more from critical care manifestations[J]. Intern Emerg Med, 2023, 18(7):1897-1918.
[4]
解飞,胡艳丽,周海,等. 环泊酚与小剂量右美托咪啶复合镇痛腹腔镜胆囊切除术治疗胆囊结石患者麻醉效果研究[J].实用肝脏病杂志,2024, 27(03): 462-465.
[5]
Strasberg SM. A three-step conceptual roadmap for avoiding bile duct injury in laparoscopic cholecystectomy: an invited perspective review [J]. J Hepatobiliary Pancreat Sci, 2019, 26(4):123-127.
[6]
吴宇,孔晓宇,张海宏,等. 早期腹腔镜胆囊切除术治疗重症急性胆囊炎的安全性和有效性[J]. 腹部外科,2024, 37(02):130-134.
[7]
刘峰,田明国,范雄伟,等. 针式组合式器械胆囊底悬吊两孔法腹腔镜胆囊切除术的技术改进及疗效分析[J]. 肝胆胰外科杂志,2024, 36(10): 612-616.
[8]
中华消化杂志编辑委员会. 中国慢性胆囊炎、胆囊结石内科诊疗共识意见(2014年,上海)[J]. 中华消化杂志,2014,34(12): 795-799.
[9]
Shah P, Saran A, Das S. Analysis of the American Society of Anesthesiologists Physical Status Scale Reliability in Anaesthesia Practice: An Observational Study[J]. Turk J Anaesthesiol Reanim, 2020, 48(5): 385-390.
[10]
Sung YT, Wu JS. The Visual Analogue Scale for Rating, Ranking and Paired-Comparison (VAS-RRP): A new technique for psychological measurement [J]. Behav Res Methods, 2018, 50(4):1694-1715.
[11]
王少渊,李春山. 双镜联合取石术与腹腔镜切除术治疗胆囊结石的并发症及近期生活质量比较[J/CD]. 中华普外科手术学杂志(电子版),2019, 13(02): 196-199.
[12]
李超,朱丽丹,汪宏,等. 基于倾向评分匹配的经脐单孔与三孔腹腔镜胆囊切除术治疗急性胆囊炎的临床疗效对比[J].临床外科杂志,2024, 32(06): 611-614.
[13]
李芳飘,姚立鹏. 两孔法保胆取石术与腹腔镜胆囊切除术治疗胆囊结石的远期预后及生活质量对比[J]. 肝胆胰外科杂志,2017, 29(01): 18-21, 39.
[14]
Vaccari S, Cervellera M, Lauro A, et al. Laparoscopic cholecystectomy: which predicting factors of conversion? Two Italian center’s studies [J]. Minerva Chir, 2020, 75(03): 141-152.
[15]
Jiang B, Ye S. Pharmacotherapeutic pain management in patients undergoing laparoscopic cholecystectomy: A review[J]. Adv Clin Exp Med, 2022, 31(11): 1275-1288.
[16]
张鑫,石明炜,罗银义,等. 单孔腹腔镜胆囊切除术中转开腹或传统腹腔镜手术的影响因素[J]. 腹腔镜外科杂志,2024,29(06): 445-450, 456.
[17]
尚培中,李晓武,苗建军,等. 腹腔镜治疗胆囊结石预防胆管损伤的两种安全策略[J/CD]. 中华普外科手术学杂志(电子版),2021, 15(03): 255-258.
[1] 赵燕玲, 王珩, 秦勤, 李静. 不同手术在食管裂孔疝合并胃食管反流病患者中的应用观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 421-424.
[2] 王浩瑜, 杨拴元, 任彦顺, 阴志强. 两种改良食管空肠吻合术的腹腔镜全胃切除术中临床对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 425-428.
[3] 林炳涛, 陈君填. 不同病理类型进展期胃癌患者临床特征及腹腔镜辅助根治术后短期预后的影响因素[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 429-433.
[4] 杨维军, 张文文, 付凯. 单切口腹腔镜下胃癌根治术治疗早中期胃癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 434-437.
[5] 党立力, 张流, 周鹏, 周华友, 赵伟. 保留左结肠动脉(升支)腹腔镜直肠癌全系膜切除术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 442-445.
[6] 曾舒昊, 康博禹, 郑高赞, 郑建勇, 丰帆. 青年结直肠癌患者的临床病理特征及预后分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 449-452.
[7] 黎伟忠, 黎嘉历, 张映南, 莫灿荣. 改良Glisson鞘外阻断在腹腔镜解剖性左半肝切除术中的应用研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 453-456.
[8] 张腾, 韩威, 冯章东. 肝内胆管结石不同微创手术方式的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 384-387.
[9] 唐健雄, 李绍杰. 我国腹腔镜疝外科治疗现状、问题与未来[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 355-358.
[10] 田文, 杨晓冬. 我国腹腔镜疝手术治疗难点与对策[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 359-361.
[11] 李涛, 朱含放, 李世拥. 我国腹腔镜疝修补术式选择与原则[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 362-365.
[12] 朱永慧, 桑迪, 张翠翠. 改良后腹膜优先原位LPD对壶腹部周围癌区域淋巴结清扫和并发症的影响研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 372-375.
[13] 张光亚, 方荣喜, 吴鹏, 肖虎. 腹腔镜下不同入肝血流阻断肝切除治疗原发性肝癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 376-379.
[14] 宁国龙, 左伟, 侯强强. 两种不同手术方案治疗Meckel憩室肠重复畸形患儿的回顾性研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 380-383.
[15] 赵军抗, 张前进, 庄惠杰. 不同导向解剖入路腹腔镜根治术治疗早期直肠癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 401-404.
阅读次数
全文


摘要