胆囊后三角解剖入路与胆囊前三角解剖入路腹腔镜胆囊切除术治疗胆囊结石患者手术效果比较研究*

doi:10.3969/j.issn.1672-5069.2025.05.036

摘要/Abstract

摘要： 目的比较胆囊后三角解剖入路与胆囊前三角解剖入路腹腔镜胆囊切除术(LC)治疗胆囊结石伴慢性胆囊炎患者的手术难易程度。方法 2021年6月～2024年6月我院收治的197例胆囊结石伴慢性胆囊炎患者均接受LC手术。在手术时,被分成两组,分别采取胆囊前三角入路101例和胆囊后三角入路96例。采用免疫比浊法检测血清C反应蛋白(CRP)水平,采用ELISA法检测血清IL-6和TNF-α水平,采用羟胺法检测血浆超氧化物歧化酶(SOD),采用DTNB直接显色法检测血浆谷胱甘肽过氧化物酶(GSH-Px),采用硫代巴比妥法检测血浆丙二醛(MDA)。采用视觉模拟评分法(VAS)评价术后疼痛。结果胆囊后三角入路组手术时间和术后排气时间分别为(33.6±7.3)min和(22.3±5.6)h,均显著短于胆囊前三角入路组【分别为(39.1±7.1)min和(28.8±6.1)h, P<0.05】,术中出血量为(36.9±11.4)mL,显著少于胆囊前三角入路组【(49.5±12.9)mL,P<0.05】;在术后3 d,胆囊后三角入路组VAS评分为(2.5±0.4)分,显著小于胆囊前三角入路组【(3.1±0.5)分,P<0.05】;在术后24 h,胆囊后三角入路组血清IL-6、IL-8、TNF-α和CRP水平分别为(12.1±2.0)ng/L、(17.3±2.7)ng/L、(19.5±2.7)ng/L和(18.3±1.6)mg/L,均显著低于胆囊前三角入路组【分别为(15.2±1.4)ng/L、(22.7±3.1)ng/L、(23.6±3.5)ng/L和(29.1±1.1)mg/L, P<0.05】;胆囊后三角入路组血清SOD水平为(121.0±18.4)U/ml,显著高于胆囊前三角入路组【(105.3±19.2)U/ml,P<0.05】。结论采用胆囊后三角解剖入路行LC手术可能更方便快捷。由于手术时间缩短,机体的氧化应激反应相对较轻。

关键词: 胆囊结石, 胆囊后三角解剖入路, 腹腔镜胆囊切除术, 治疗

Abstract: Objective The purpose of this study was to compare laparoscopic cholecystectomy (LC) by through posterior Calot’ s triangle approach (PCTA) or through anterior Calot’ s triangle approach (ACTA) in dealing with patients with cholecystolithiasis and chronic cholecystitis. Methods 197 patients with cholecystolithiasis and chronic cholecystitis were encountered in our hospital between June 2021 and June 2024, and all underwent LC surgery. For the operation, by through PCTA in 96 cases, and by through ACTA in 101 cases. Visual analogue scale (VAS) was evaluated for postoperative pain. Serum C-reactive protein level was detected by immunoturbidimetry, serum interleukin (IL)-6 and tumor necrosis factor (TNF)-α were detected by ELISA, plasma superoxide dismutase (SOD) level was detected by ammonium phosphate method, plasma glutathione peroxidase (GSH-Px) level was detected by DTNB direct color development, and plasma malondialdehyde (MDA) level was assayed by thiobarbituric acid. Results Surgical time and postoperative exhaust time in PCTA group were(33.6±7.3)min and (22.3±5.6)h, both much shorter than [(39.1±7.1) minand (28.8±6.1)h, respectively, P<0.05], and operational bleeding was (36.9±11.4)mL, much less than [(49.5±12.9)mL, P<0.05] in ACTA group; by end of three days, VAS score in PCTA group was (2.5±0.4)points, much lower than [(3.1±0.5)points, P<0.05] in ACTA group; by 24 h, serum IL-6, IL-8, TNF-α and CRP levels in PCTA group were (12.1±2.0)ng/L, (17.3±2.7)ng/L, (19.5±2.7)ng/L and (18.3±1.6)mg/L, all significantly lower than [(15.2±1.4)ng/L, (22.7±3.1)ng/L, (23.6±3.5)ng/L and (29.1±1.1)mg/L, respectively, P<0.05] in ACTA group; serum SOD level was (121.0±18.4)U/ml, much higher than [(105.3±19.2)U/ml, P<0.05]in ACTA group. Conclusion For LC operation, by through PCTA could be relatively easy, which might cost less operational time and induce less body inflammatory and oxidative stress.

Key words: Cholecystolithiasis, Chronic cholecystitis, Laparoscopic cholecystectomy, Posterior Calot’ s triangle approach, Therapy

张文杰, 周黎晨, 刘宇, 甘元涛, 赵杰. 胆囊后三角解剖入路与胆囊前三角解剖入路腹腔镜胆囊切除术治疗胆囊结石患者手术效果比较研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 784-787.

Zhang Wenjie, Zhou Lichen, Liu Yu, et al. Comparison of laparoscopic cholecystectomy by through posterior Calot’ s triangle approach or through anterior Calot’ s triangle approach in dealing with patients with cholecystolithiasis and chronic cholecystitis[J]. Journal of Practical Hepatology, 2025, 28(5): 784-787.

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胆囊后三角解剖入路与胆囊前三角解剖入路腹腔镜胆囊切除术治疗胆囊结石患者手术效果比较研究^*

Comparison of laparoscopic cholecystectomy by through posterior Calot’ s triangle approach or through anterior Calot’ s triangle approach in dealing with patients with cholecystolithiasis and chronic cholecystitis

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