腹腔镜胆囊切除术胆囊前三角与胆囊后三角入路对比分析(1)
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[摘要] 目的 分析经胆囊后三角入路行腹腔镜胆囊切除术(LC)的安全性及临床应用价值。方法 将120例拟行LC患者分为无粘连组57例和粘连组63例，无粘连组分别有29例和28例行经胆囊前三角入路LC和胆囊后三角入路LC；粘连组有28例和35例行经胆囊前三角入路LC和胆囊后三角入路LC。结果 粘连组两种入路的手术时间及术中出血量均大于无粘连组，差异具有统计学意义(P<0.05)；粘连组中胆囊后三角入路手术时间和出血量均显著少于胆囊前三角入路，差异具有统计学意义(P<0.05)；两组中胆囊后三角入路并发症及术中中转开腹例数均较胆囊前三角入路少(P<0.05)。结论 胆囊后三角入路三孔法LC安全可行、容易掌握，手术并发症少，尤其适用于胆囊三角存在粘连的患者。
[关键词] 胆囊后三角；腹腔镜；胆囊切除术
[中图分类号] R657.4 [文献标识码] B [文章编号] 1673-9701(2011)26-135-02
Comparative and Analysis of the Former and Posterior Calot’s Triangle Approach in Laparoscopic Cholecystectomy
YU Xuejun XU Jiafa CHU Xiufeng ZHANG Ju
Department of Hepatobiliary Surgery， China Medical Shaoxing Hospital，Shaoxing 312030，China
[Abstract] Objective To investigate the security and value of the posterior Calot’s triangle approach in 1aparoscopic cholecystectomy(LC). Methods All 120 cases of LC， divide into adhesion group and non- adhesion group on the basis of if had adhesion among the cholecyst，29 cases and 28 cases were treated by the the former and posterior Calot’s triangle approach in LC in the non- adhesion group，28 cases and 35 cases were treated by the the former and posterior Calot’s triangle approach in LC in the adhesion group. Results The times and the amount of bleeding in the LC between the tow groups had statistically significant difference(P<0.05).The times and the amount of bleeding in the LC between the tow approach had statistically significant difference(P<0.05).The complications and cases of turn to open surgery between the tow approach in the adhesion group had statistically significant difference(P<0.05). Conclusion the posterior Calot’s triangle approach in LC is safe and feasible，less complications，especially apply appropriate for the cases with adhesion among the cholecyst .
[Key words] Posterior calot’s triangle；Laparoscopic；Cholecystectomy
腹腔镜胆囊切除术(1aparoscopic cholecystectomy，LC)以微创、恢复快速已成为治疗胆囊良性外科疾病的首选方法。由于LC操作的间接性特点，胆囊管及胆囊三角的剥离是最难处理的部分，较易出现胆管损伤等严重并发症。并发症的发生率均高于传统的开腹切除术，为2.0%～5.4%[1]。为提高LC处理胆囊三角的安全性，降低并发症的发生，本研究对比LC胆囊前三角入路与胆囊后三角入路操作的安全性及术后的并发症，现报道如下。
1 资料与方法
1.1 一般资料
2009年1月～2010年12月我院收治经B超或CT或MRCP明确诊断拟行LC的患者120例 ......
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