改良式经脐单孔腹腔镜与传统腹腔镜胆囊切除术临床对比研究

发布时间：2018-04-26 18:13

本文选题：改良式单孔手术 + 腹腔镜　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的探讨改良式经脐单孔腹腔镜胆囊切除术(transumbilical single-port l aparoscopic cholecystectomy,TSPLC)在临床应用的安全可行性、优越性及经验体会。方法回顾性病例对照研究方法分析我院2014年1月至2016年10月行胆囊切除术100例患者(单孔组为50例,三孔组为50例)的临床资料,研究对比两组围手术期相关性临床指标(手术时间、术中出血量、术后疼痛评分、术后止痛药物的利用率、住院时间、切口满意度、切口并发症及单孔组组内手术时间),同时通过抽取外周静脉血检测并对比相关实验室指标:不同时间点的创伤指标[C反应蛋白(C react ion protein,CRP)、白细胞计数(white blood cell count,WBC)]和免疫学指标[(immune globulin M,Ig M)、CD3+(cluster of differentiation 3,CD3+)]。结果两组患者均成功完成手术,均未放置引流管。术前一般情况观察指标无统计学差异(P0.05);两组手术时间具有显著性差异(P0.01),单孔组手术时间(71.66±12.36)min,而三孔组(46.88±7.32)min;单孔组术后6h疼痛评分(3.66±1.39)及术后止痛药物利用率(8%)均明显低于三孔组[6h疼痛评分(4.22±0.91),P=0.034;止痛药物利用率(31.25%),P0.01];术后患者对切口的满意度经脐单孔组(96.06±2.98)明显高于传统三孔组(79.66±6.52)(P0.01);两组术中出血量、术后24h疼痛评分及住院时间无统计学意义(P0.05);在最初10例患者中单孔组平均手术时间为(89.40±8.28)min,而后20例平均手术时间(62.90±9.76)min,有显著性差异(P0.01),线性回归分析提示单孔组手术时间随着手术量的增加而逐渐缩短(r=-0.426,p0.01),但仍较传统三孔组手术时间(46.88±7.32)min长,差异具有统计学意义(PO.01);术前1d、术后1d、术后3d单孔组与三孔组CRP、WBC,Ig M、CD3+值组间比较,两组间无明显差异(P0.05);术后随访2~3个月,无切口疝等并发症发生。结论相对于传统LC,TSPLC在术后恢复、切口疼痛、美容效果等方面有明显的优势,同时,对手术器械要求不高,传统器械就能完成,手术时间随着手术量的增加和经验的积累呈缩短的趋势。此外,对机体创伤反应及免疫功能的影响较传统LC相似,说明改良式TSPLC是安全可行性,并不增加手术风险,对于已开展LC的基层医院,具有一定的推广价值。但手术技术要求较高,操作难度较大,学习曲线时间相对较长,需要有一定腹腔镜手术经验的外科医师才能完成。
[Abstract]:Objective to investigate the safety, superiority and experience of modified transumbilical single-port L aparoscopic cholecystectomy (TSPLC) in clinical application. Methods 100 cases of cholecystectomy (single hole group) in our hospital from January 2014 to October 2016 were analyzed by retrospective case control study. The clinical data of 50 cases and 50 cases of three hole group were compared and compared between the two groups of perioperative related clinical indexes (operation time, intraoperative bleeding volume, postoperative pain score, postoperative analgesic drug utilization, hospitalization time, incision satisfaction, incision complication and single hole group operation time). Meanwhile, peripheral venous blood was detected and compared. [C reactive protein (C react ion protein, CRP), leukocyte count (white blood cell count, WBC)) and immunological indexes were performed successfully in all two groups. There was no statistical difference between the two groups (P0.01), the operation time of the single hole group (71.66 + 12.36) min, and the three hole group (46.88 + 7.32) min, and the 6h pain score (3.66 + 1.39) after the single hole group and the postoperative analgesic drug use rate (8%) were significantly lower than that of the three hole group (4.22 + 0.91), P=0.034, and pain relief. The drug utilization rate (31.25%), P0.01], the postoperative satisfaction of the patients on the incision was significantly higher than that of the traditional three hole group (96.06 + 2.98) (79.66 + 6.52) (79.66 + 6.52). The amount of bleeding in the two groups, the postoperative 24h pain score and the time of hospitalization were not statistically significant (P0.05), and the average operation time of the first 10 patients was (89.40 + 8.28) min, but the average time of operation was (P0.05) in the first 10 patients. The average operation time of the 20 cases (62.90 + 9.76) min was significant (P0.01). The linear regression analysis showed that the operation time of single hole group gradually shortened with the increase of operation volume (r=-0.426, P0.01), but it was still longer than that of the traditional three hole group (46.88 + 7.32) min, and the difference was statistically significant (PO.01); before operation 1D, postoperative 1D, 3D single hole group after operation and after operation. There was no significant difference between the two groups in the group of three holes CRP, WBC, Ig M and CD3+. The postoperative follow-up was 2~3 months and no incision hernia occurred. Conclusion compared with traditional LC, TSPLC has obvious advantages in postoperative recovery, incision pain, beauty effect and so on. At the same time, the requirements for surgical instruments are not high, and the traditional instruments can be completed and operation time. With the increase of the amount of operation and the accumulation of experience, the effect on the injury reaction and immune function of the body is similar to that of the traditional LC. It shows that the improved TSPLC is safe and feasible, and does not increase the risk of operation. It has a certain promotion value for the primary hospital which has developed LC, but the operation technology is higher and the operation difficulty is more difficult. The learning curve is relatively long and requires surgeons who have some experience in laparoscopic surgery.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.4

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