Rouviere沟引导胆囊后隧道解剖用于困难腹腔镜胆囊切除术

doi:10.16139/j.1007-9610.2022.03.011

摘要/Abstract

摘要：

目的：探讨Rouviere沟引导胆囊后隧道解剖用于困难腹腔镜胆囊切除术。方法：回顾分析2019年1月至2020年10月,滕州市中心人民医院收治的腹腔镜胆囊切除术病人1 081例,依据Gupta的术前评分系统,将评分≥6分的困难胆囊病人125例,分为Rouviere沟引导胆囊切除组（研究组）65例和传统腹腔镜胆囊切除组（对照组）60例。比较两组病人的临床资料、手术和术后并发症发生情况。结果：研究组与对照组的手术时间（61±23） min比（88±24） min（P<0.05）,术中出血量（46±16） mL比（62±23） mL（P<0.05）,住院时间（3.5±1.5） d比（5.8±2.2） d（P<0.05）,人均住院费（12 236±316）元比（14 199±552）元（P<0.05）,术后12 h和24 h疼痛视觉模拟评分（2.7±1.1）分和（3.0±1.1）分比（5.9±1.0）分和（6.4±1.5）分（P<0.05）,差异均有统计学意义。中转开腹研究组1例,对照组6例。研究组无胆漏,对照组胆漏4例,差异有统计学意义（P<0.05）。研究组术后72 h肝功能较术前改善程度明显优于对照组（P<0.05）。研究组无胆管损伤,对照组胆管损伤1例（P>0.05）。结论：Rouviere沟引导胆囊后隧道解剖行困难胆囊切除术可成为安全腹腔镜胆囊切除术。

关键词: 腹腔镜胆囊切除术, 困难胆囊, Rouviere沟, 胆囊后隧道

Abstract:

Objective To explore Rouviere′s sulcus guided retro-gallbladder tunnel dissection cholecystectomy used in difficult laparoscopic cholecystectomy. Methods A retrospective analysis of 1 081 patients with laparoscopic cholecystectomy in Tengzhou Central People′s Hospital from January 2019 to October 2020 was done. A total of 125 cases had scores ≥6 indicating difficult laparoscopic cholecystectomy based on preoperative scoring system to predict difficult laparoscopic cholecystectomy by Gupta. There were 65 cases(study group) with laparoscopic cholecystectomy using Rouviere′s sulcus guided retro-gallbladder tunnel dissection and 60 cases(control group) with routine laparoscopic cholecystectomy. Clinical data with operation and postoperative complication were compared between two groups. Results Operative time of two groups was [(61±23) min vs. (88±24) min], operative blood loss [(46±16) mL vs. (62±23) mL, hospital length of stay [(3.5±1.5) d vs. (5.8±2.2) d] and hospital cost [(12 236±316) yuan vs. (14 199±552) yuan] with statistical significant difference (P<0.05). Visual analog scale at 12 h and 24 h after operation in study group were (2.7±1.1) and (3.0±1.1), less than those in control group (5.9±1.0) and (6.4±1.5) significantly(P<0.05). One case with conversion of laparotomy was present in study group and 6 cases in control group (P<0.05). There was no case with bile leakage in study group and 4 cases in control group (P<0.05). Liver function was more improved significantly 72 hours postoperative in study group than in control group (P<0.05). There was no bile duct injury in study group and 1 bile duct injury in control group (P>0.05). Conclusions Rouviere′s sulcus guided retro-gallbladder tunnel dissection in difficult cholecystectomy could be safe laparoscopic cholecystectomy.

Key words: Laparoscopic cholecystectomy, Difficult gallbladder, Rouviere′s sulcus, Retro-gallbladder tunnel

中图分类号:

R657.4

满高亚, 党同科, 吴清松, 冯飞灵. Rouviere沟引导胆囊后隧道解剖用于困难腹腔镜胆囊切除术[J]. 外科理论与实践, 2022, 27(03): 239-243.

MAN Gaoya, DANG Tongke, WU Qingsong, FENG Feiling. Rouviere′s sulcus guided retro-gallbladder tunnel dissection in difficult laparoscopic cholecystectomy[J]. Journal of Surgery Concepts & Practice, 2022, 27(03): 239-243.

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项目	分值
年龄（岁） ≤50 >50	0 1
性别男女	1 0
既往急性胆囊炎病史有无查体触及肿大胆囊有无影像学检查胆囊壁厚度（mm） <4 ≥4 胆囊颈管结石嵌顿无有胆囊周围粘连无有	4 0 1 0 0 2 0 2 0 1

项目	研究组（n）	对照组（n）	t/χ²	P值
年龄（岁）	49.5±6.1	49.8±5.9	t=0.279	>0.05
性别男女	39 26	37 23	χ²=0.036	0.849
既往急性胆囊炎发作史查体触及肿大胆囊影像学检查胆囊壁厚≥4 mm 胆囊颈管结石嵌顿胆囊周围粘连渗出难度评分分值（分）	6 5 40 12 7 10.5±1.3	5 4 38 11 6 10.7±1.2	χ²=0.031 χ²=0.049 χ²=0.043 χ²=0.000 χ²=0.020 t=0.378	0.863 0.825 0.836 0.985 0.888 >0.05

项目	研究组	对照组	t/χ²	P值
手术时间（min）	61±23	88±24	t=6.422	<0.05
术中出血量（mL）	46±16	62±23	t=4.543	<0.05
胆管损伤胆漏中转开腹住院时间（d）人均住院费（元）	0 0 1 3.5±1.5 12 236±316	1 4 6 5.8±2.2 14 199±552	χ²=1.091 χ²=4.477 χ²=4.225 t=6.875 t=24.634	0.296 0.034 0.040 <0.05 <0.05

项目	时间	研究组	对照组	t值	P值
天冬氨酸转氨酶（U/L）	术前	90.4±5.5	89.9±5.8
天冬氨酸转氨酶（U/L）	术后72 h	23.1±5.1	52.3±6.1	32.822	<0.05
丙氨酸转氨酶（U/L）	术前	79.3±3.8	79.1±4.1
丙氨酸转氨酶（U/L）	术后72 h	21.8±3.6	47.2±7.5	36.110	<0.05
总胆红素（mol/L）	术前	16.8±2.4	16.7±2.5
总胆红素（mol/L）	术后72 h	15.1±2.1	15.0±2.2	0	>0.05
碱性磷酸酶（U/L）	术前	113.3±5.7	112.9±5.9
碱性磷酸酶（U/L）	术后72 h	68.1±3.0	70.2±4.1	1.538	>0.05

术后时间	研究组	对照组	t值	P值
术后12 h	2.7±1.1	5.9±1.0	16.971	<0.05
术后24 h 术后48 h	3.0±1.1 2.9±1.5	6.4±1.5 3.0±1.6	14.582 0.361	<0.05 >0.05