王一帆 1叶伟明 2周晓荻 3牛洋 1丁洁茹 2戴思源 3杨陈凤麟 2张起帆2
作者信息
- 1. 息县人民医院普外科一病区,河南 信阳 464300
- 2. 南方医科大学南方医院肝胆外科,广东 广州 510515
- 3. 南方医科大学第一临床医学院,广东 广州 510515
- 折叠
摘要
Abstract
Objective To explore the application clinical efficacy of laparoscopic difficult cholecystectomy via the cystic plate approach(CPA).Methods A retrospective analysis was conducted on the clinical data of 74 patients who underwent laparoscopic difficult cholecystectomy at Xixian People's Hospital,Henan Province,from January 2023 to June 2024.Among them,25 patients underwent laparoscopic difficult cholecystectomy via the CPA(CPA group),and 49 patients underwent laparoscopic difficult cholecystectomy via the conventional approach(conventional group).After propensity score matching(PSM)with covariates including age,gender,body mass index(BMI),gallbladder wall thickness,and acute-phase surgery,24 patients were allocated to each group for comparative analysis.Results After PSM,no statistically significant differences were observed in baseline characteristics between the two groups(P>0.05).Compared to the conventional group,the CPA group demonstrated a lower incidence of intraoperative blood loss exceeding 20 mL[8.3%(2/24)vs 33.3%(8/24),χ2=4.547,P=0.033],shorter operation time[56.0(40.0,67.0)min vs 64.5(58.5,85.75)min,Z=-2.193,P=0.028],and less total hospitalization costs[8 173.5(7 453.8,9 015.8)CNY vs 9 954.2(7 029.8,10 241.5)CNY,Z=-2.248,P=0.025].There were no statistically significant differences between the two groups in preoperative C-reactive protein levels,rates of accidental gallbladder injury,or postoperative white blood cell counts(P>0.05).Conclusion Laparoscopic difficult cholecystectomy via the CPA is safe,practical,and does not have technical barriers in primary hospital.Compared to the conventional approach,it can reduce intraoperative blood loss and operation time,thereby shortening the hospital stay and reducing medical expenses.关键词
困难胆囊/腹腔镜困难胆囊切除术/胆囊板入路/Laennec膜/基层医院Key words
difficult gallbladder/laparoscopic diffifut cholecystectomy/cystic plate approach/Laennec membrane/primary hospital分类
医药卫生
