关键词: 胆囊结石, 腹腔镜胆囊切除术, Calot三角, 解剖入路, 治疗

Abstract: Objective To analyze the efficacy of different Calot triangle anatomical approaches during laparoscopic cholecystectomy（LC） in the treatment of patients with gallbladder stones with chronic cholecystitis. Methods 200 patients with gallbladder stones with chronic cholecystitis were divided into two groups according to different Calot triangle anatomical approaches during LC,and 100 patients received LC by posterior gallbladder triangle anatomical approach（observation group） and another 100 by gallbladder triangle approach （control group）. The operation indexes were compared,and serum cytokines were detected by ELISA. Results We found 53 patients in observation group and 50 in control having adhesion around gallbladder during LC. There was no significant differences between the two groups without adhesion as respect to operational indexes,complications and the rates of conversion to laparotomy（P>0.05）;The operation time,intraoperative bleeding,time for intestinal function recovery after operation,hospital stay and postoperative visual analogue scale （VAS） score of pain in patients with adhesion in the observation group were（29.4±4.3） min,（33.9±4.6） ml,（26.0±4.2） h,（6.0±1.0） d,and（4.0±1.5）,significantly shorter,lesser or lower than those in patients with adhesion in the control group [（59.1±5.5） min,（45.6±4.1） ml,（30.3±4.5） h,（8.4±1.0） d,and （4.8±1.3）,P<0.05];There was not incidence of complications or conversion to laparotomy in patients with adhesion around gallbladder in the observation group, while they were 8.0% and 8.0% in patients with adhesion around gallbladder in the control group （P<0.05）;Serum levels of C reactive protein, interleukin-6,interleukin -8 and tumor necrosis factor α after operation in the observation group were significantly lower than those in the control group（P<0.05）. Conclusion Posterior gallbladder triangle anatomical approach can significantly reduce bleeding in patients with gallbladder adhesion, significantly decrease the incidence of complications and the rate of conversion to open operation. In laparoscopic cholecystectomy,the gallbladder adhesion needs to be observed closely and dealt with properly.

Key words: Gallbladder stones, Laparoscopic cholecystectomy, Calot triangle, Anatomical approach, Therapy