摘要
目的探讨三孔法腹腔镜胆囊切除术(LC)精细化多维度技术升级方案及其临床价值。方法回顾性分析2021年1月至2023年2月温州医科大学附属第一医院100例LC患者临床资料,分为精细化三孔组(50例)和传统三孔组(50例)。精细化三孔组的技术升级方案包括切皮前腹横筋膜前神经阻滞镇痛、切口功能重塑、简易胆囊壶腹部悬吊牵引技术及胆囊管和胆囊动脉的可吸收线闭合体系。比较两组手术时间、术中出血量、疼痛评分、并发症情况、切口满意度、异物残留及日间手术退出率等指标。结果精细化三孔组剑突下切口直径显著缩小[(4.9±0.2)mm vs(10.9±0.8)mm],术后VAS疼痛评分明显降低[术后6 h:(2.9±0.7)vs(3.8±0.5);术后24 h:(2.1±0.3)vs(2.9±0.7)];差异均具有统计学意义(P<0.05)。精细化三孔组无体内异物残留,传统三孔组术后发生1例Hem-o-lok夹移位。精细化三孔组日间手术退出率降低(8.00%vs 42.00%),住院费用减少[(11095.4±1388.5)元vs(12340.8±1716.1)元],差异均具有统计学意义(P<0.05)。结论LC精细化多维度技术升级方案在降低手术创伤、消除异物残留及优化术后恢复方面具有显著优势,适用于日间LC手术及在基层医院的推广。
Objective To evaluate the clinical value of a refined multi-dimensional technical upgrade scheme for three-port laparoscopic cholecystectomy(LC).Methods A retrospective analysis was conducted on 100 patients,who underwent LC from Jan.2021 to Feb.2023 in the First Affiliated Hospital of Wenzhou Medical University.Patients were divided into the refined three-port group(n=50)and the traditional three-port group(n=50).Technical upgrades included pre-incisional transversus abdominis plane block,functional incision remodeling,simplified gallbladder traction,and absorbable suture closure.Outcomes including operation time,intraoperative blood loss,pain scores,complications,incision satisfaction,residual foreign bodies,and dropout rates of ambulatory surgery were compared between the two groups.Results The refined three-port group showed smaller subxiphoid incisions[(4.9±0.2)mm vs(10.9±0.8)mm],lower postoperative VAS pain scores[6 h:(2.9±0.7)vs(3.8±0.5);24 h:(2.1±0.3)vs(2.9±0.7)],the differences were statistically significant(P<0.05).No residual foreign body was observed in the refined three-port group,while 1 case of Hem-o-lok clip migration occurred in the traditional three-port group.The refined three-port group also showed lower dropout rates of ambulatory surgery(8.00%vs 42.00%,P<0.001)and lower hospitalization costs[(11095.4±1388.5)CNY vs(12340.8±1716.1)CNY],the differences were statistically significant(P<0.05).Conclusion The refined multi-dimensional technique for three-port LC reduces surgery trauma,eliminates foreign body retention,and optimizes postoperative recovery,demonstrating significant clinical benefits for ambulatory surgery and primary healthcare settings.
作者
陈云志
郑孺
孔鸿儒
单云峰
张启瑜
CHEN Yunzhi;ZHENG Ru;KONG Hongru;SHAN Yunfeng;ZHANG Qiyu(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)
出处
《肝胆胰外科杂志》
2025年第6期361-365,371,共6页
Journal of Hepatopancreatobiliary Surgery
基金
温州市科技局基础性科研项目(Y20210943)。
关键词
腹腔镜胆囊切除术
胆囊悬吊
可吸收线
三孔法手术
日间手术
laparoscopic cholecystectomy
gallbladder suspension
absorbable line
three-port surgery
ambulatory surgery
