本文選題：改良式單孔手術(shù) + 腹腔鏡��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討改良式經(jīng)臍單孔腹腔鏡膽囊切除術(shù)(transumbilical single-port l aparoscopic cholecystectomy,TSPLC)在臨床應(yīng)用的安全可行性、優(yōu)越性及經(jīng)驗(yàn)體會(huì)。方法回顧性病例對(duì)照研究方法分析我院2014年1月至2016年10月行膽囊切除術(shù)100例患者(單孔組為50例,三孔組為50例)的臨床資料,研究對(duì)比兩組圍手術(shù)期相關(guān)性臨床指標(biāo)(手術(shù)時(shí)間、術(shù)中出血量、術(shù)后疼痛評(píng)分、術(shù)后止痛藥物的利用率、住院時(shí)間、切口滿意度、切口并發(fā)癥及單孔組組內(nèi)手術(shù)時(shí)間),同時(shí)通過抽取外周靜脈血檢測(cè)并對(duì)比相關(guān)實(shí)驗(yàn)室指標(biāo):不同時(shí)間點(diǎn)的創(chuàng)傷指標(biāo)[C反應(yīng)蛋白(C react ion protein,CRP)、白細(xì)胞計(jì)數(shù)(white blood cell count,WBC)]和免疫學(xué)指標(biāo)[(immune globulin M,Ig M)、CD3+(cluster of differentiation 3,CD3+)]。結(jié)果兩組患者均成功完成手術(shù),均未放置引流管。術(shù)前一般情況觀察指標(biāo)無統(tǒng)計(jì)學(xué)差異(P0.05);兩組手術(shù)時(shí)間具有顯著性差異(P0.01),單孔組手術(shù)時(shí)間(71.66±12.36)min,而三孔組(46.88±7.32)min;單孔組術(shù)后6h疼痛評(píng)分(3.66±1.39)及術(shù)后止痛藥物利用率(8%)均明顯低于三孔組[6h疼痛評(píng)分(4.22±0.91),P=0.034;止痛藥物利用率(31.25%),P0.01];術(shù)后患者對(duì)切口的滿意度經(jīng)臍單孔組(96.06±2.98)明顯高于傳統(tǒng)三孔組(79.66±6.52)(P0.01);兩組術(shù)中出血量、術(shù)后24h疼痛評(píng)分及住院時(shí)間無統(tǒng)計(jì)學(xué)意義(P0.05);在最初10例患者中單孔組平均手術(shù)時(shí)間為(89.40±8.28)min,而后20例平均手術(shù)時(shí)間(62.90±9.76)min,有顯著性差異(P0.01),線性回歸分析提示單孔組手術(shù)時(shí)間隨著手術(shù)量的增加而逐漸縮短(r=-0.426,p0.01),但仍較傳統(tǒng)三孔組手術(shù)時(shí)間(46.88±7.32)min長,差異具有統(tǒng)計(jì)學(xué)意義(PO.01);術(shù)前1d、術(shù)后1d、術(shù)后3d單孔組與三孔組CRP、WBC,Ig M、CD3+值組間比較,兩組間無明顯差異(P0.05);術(shù)后隨訪2~3個(gè)月,無切口疝等并發(fā)癥發(fā)生。結(jié)論相對(duì)于傳統(tǒng)LC,TSPLC在術(shù)后恢復(fù)、切口疼痛、美容效果等方面有明顯的優(yōu)勢(shì),同時(shí),對(duì)手術(shù)器械要求不高,傳統(tǒng)器械就能完成,手術(shù)時(shí)間隨著手術(shù)量的增加和經(jīng)驗(yàn)的積累呈縮短的趨勢(shì)。此外,對(duì)機(jī)體創(chuàng)傷反應(yīng)及免疫功能的影響較傳統(tǒng)LC相似,說明改良式TSPLC是安全可行性,并不增加手術(shù)風(fēng)險(xiǎn),對(duì)于已開展LC的基層醫(yī)院,具有一定的推廣價(jià)值。但手術(shù)技術(shù)要求較高,操作難度較大,學(xué)習(xí)曲線時(shí)間相對(duì)較長,需要有一定腹腔鏡手術(shù)經(jīng)驗(yàn)的外科醫(yī)師才能完成。
[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.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.4

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本文編號(hào)：1807101