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.