Clinical comparison of lateral approach and antegrade/retrograde dissection laparoscopic cholecystectomy for acute cholecystitis with gallstones

doi:10.3877/cma.j.issn.1674-3946.2022.02.023

Abstract

Abstract:

Objective

To compare the clinical efficacy and safety of laparoscopic cholecystectomy with lateral approach and antegrade/retrograde dissection in the treatment of acute cholecystitis and cholecystolithiasis.

Methods

The clinical data of 80 patients with acute complicated with gallstones admitted from March 2017 to March 2020 were prospectively studied. They were selected and randomly divided into lateral group and antegrade/retrograde group，with 40 cases in each group. Laparoscopic cholecystectomy was performed by lateral approach and anterograde/retrograde stripping respectively. SPSS 22.0 statistical software was used to analyze the data. T Postoperative complications and other counting data were analyzed by（χ² test）was used. Perioperative indicators and other measurement data were expressed as（

x ˉ

±s）and independent sample t test was used.

Results

The intraoperative blood loss and the incidence of gallbladder rupture in the lateral group were lower than those in the antegrade/retrograde group（P<0.05）. The indwelling time，drainage volume and postoperative hospital stay of lateral approach drainage tube were lower than those of the antegrade/retrograde group（P<0.05）. There were no complications such as bile duct injury，biliary fistula，massive hemorrhage and abdominal infection in the two groups. The average follow-up time was（1.3±0.4）years. No stone recurrence was found during the follow-up.

Conclusion

Compared with antegrade/retrograde gallbladder dissection，lateral laparoscopic cholecystectomy can reduce the intraoperative trauma and promote postoperative recovery in patients with acute cholecystitis and cholecystolithiasis.

Key words: Cholecystitis，acute, Cholecystolithiasis, Cholecystectomy，Laparoscopic, Lateral approach, Antegrade/retrograde dissection

Chun Zhang, Zhuoyu Ma, Dalu Liu, Xu Zhu. Clinical comparison of lateral approach and antegrade/retrograde dissection laparoscopic cholecystectomy for acute cholecystitis with gallstones[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(02): 204-206.

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组别	例数	性别（男/女）	年龄（岁）	BMI （kg/m²）	病程（h）	结石类型（单发/多发）
侧方组	40	16/24	43.3±8.8	24.3±2.6	25.3±5.0	21/19
顺/逆行组	40	19/21	43.5±8.6	24.3±2.8	25.1±5.2	23/17
t/χ²值	-	0.457	0.108	0.066	0.168	0.202
P值	-	0.499	0.914	0.947	0.867	0.653

组别	例数	性别（男/女）	年龄（岁）	BMI （kg/m²）	病程（h）	结石类型（单发/多发）
侧方组	40	16/24	43.3±8.8	24.3±2.6	25.3±5.0	21/19
顺/逆行组	40	19/21	43.5±8.6	24.3±2.8	25.1±5.2	23/17
t/χ²值	-	0.457	0.108	0.066	0.168	0.202
P值	-	0.499	0.914	0.947	0.867	0.653

组别	例数	手术时间（min）	术中出血量（ml）	首次通气时间(d)	首次进食时间(d)
侧方组	40	71.5±22.3	25.1±6.1	1.2±0.3	1.7±0.3
顺/逆行组	40	68.8±26.1	50.6±13.1	1.3±0.3	1.6±0.3
t/χ²值	-	0.505	11.132	0.550	0.574
P值	-	0.615	0.000	0.584	0.567
组别	例数	引流管留置时间(d)	引流量（ml）	术后住院时间(d)	胆囊破裂（%）
侧方组	40	2.8±0.5	16.2±2.7	4.0±0.7	1（2.50）
顺/逆行组	40	3.5±0.7	71.4±17.4	5.0±0.8	8（20.00）
t/χ²值	-	5.410	19.787	6.168	4.507
P值	-	0.000	0.000	0.000	0.034

组别	例数	手术时间（min）	术中出血量（ml）	首次通气时间(d)	首次进食时间(d)
侧方组	40	71.5±22.3	25.1±6.1	1.2±0.3	1.7±0.3
顺/逆行组	40	68.8±26.1	50.6±13.1	1.3±0.3	1.6±0.3
t/χ²值	-	0.505	11.132	0.550	0.574
P值	-	0.615	0.000	0.584	0.567
组别	例数	引流管留置时间(d)	引流量（ml）	术后住院时间(d)	胆囊破裂（%）
侧方组	40	2.8±0.5	16.2±2.7	4.0±0.7	1（2.50）
顺/逆行组	40	3.5±0.7	71.4±17.4	5.0±0.8	8（20.00）
t/χ²值	-	5.410	19.787	6.168	4.507
P值	-	0.000	0.000	0.000	0.034

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