3D与2D腹腔镜在复杂性胆囊切除术中的前瞻性对比研究

Comparison of 3D and 2D laparoscopic cholecystectomy for complicated gallstone disease: a prospective study

摘要:

前瞻性对比3D与2D腹腔镜在复杂性胆囊切除术中的临床应用价值。方法?采用前瞻性随机对照的研究方法，选取2014年1月－2016年1月根据入组和排除标准连续收集的需行复杂性胆囊切除术的患者的临床病例资料。利用随机数表随机分为3D腹腔镜组和2D腹腔镜组，由同一组手术医生完成手术，比较两组患者手术情况和远期随访情况。结果?依据入组条件，共计入组患者96例，3D组48例，2D组48例。①手术情况：所有患者均顺利完成手术，无围手术期死亡及二次手术患者；3D组的手术时间和术中出血量均少于2D组[（132.2±76.4）vs（156.5±89.3）min，P =0.000；（35.6±35.4）vs（55.9±44.1）ml，P =0.000]，差异有统计学意义；两组的中转开腹率（6.3% vs 10.4%，P =0.203）和并发症发生率（20.8% vs 25.0%，P =0.445）无明显差别；3D与2D组的术后排气时间[（48.7±13.2） vs （49.6±14.1）h，P =0.692]、腹腔引流管留置时间[（3.5±1.1）vs （3.6±1.3）d，P =0.394]和住院时间[（5.1±1.5） vs （5.2±1.7）d，P =0.311]差异均无统计学意义；②远期随访：全部患者获得随访，随访时间12～40个月，中位随访时间28个月；3D组6例出现消化不良，4例出现右上腹不适，2例出现残余胆囊结石；2D组4例出现消化不良，5例出现右上腹不适，1例出现残余胆囊结石。结论?3D腹腔镜依靠其高清的视野和良好的纵深感，在复杂胆囊切除术中安全有效，并有利于减少患者的出血量和缩短手术时间，值得临床推广应用。

Abstract:

To prospectively compare the clinical effects of 3D and 2D laparoscopic cholecystectomy for complicated gallstone disease. Methods The prospective and randomized study was conducted. From January 2014 to January 2016, clinical data of patients with complicated gallbladder mastectomy were continuously collected. Patients were randomly divided into 3D laparoscopic group and 2D laparoscopic group based on random number table. The surgeries were performed by the same group of surgeons. The two groups were compared for surgical outcomes and long-term follow-up. Results According to the enrollment criteria, a total of 96 patients were included with 48 cases of 3D group and 48 cases of 2D group. Surgical comparison: All patients were successfully completed the operation with no perioperative death or secondary surgery. The operative time [ (132.2 ± 76.4) vs (156.5 ± 89.3) min, P = 0.000] and intraoperative blood loss [(35.6 ± 35.4) vs (55.9 ± 44.1) ml, P = 0.000] of 3D group were lower than those of 2D group with statistical significance (P < 0.01). There were no significant differences between the two groups in the rate of laparotomy (6.3% vs 10.4%, P = 0.203) and complication (20.8% vs 25.0%, P = 0.445). There were no significant differences in postoperative exhaust time [(48.7 ± 13.2) vs (49.6 ± 14.1) h, P = 0.692], time of abdominal drainage tube [(3.5 ± 1.1) vs (3.6 ± 1.3) d, P = 0.394] and hospital stay [(5.1 ± 1.5) vs (5.2 ± 1.7) d, P = 0.311] between 3D and 2D groups; Follow-up comparison: All patients were followed up for 12 ~ 40 months with a median follow-up of 28 months. In 3D group, there were 6 cases of dyspepsia, 4 cases of right upper quadrant discomfort and 2 cases of residual gallstones. In 2D group, there were 4 cases of dyspepsia, 5 cases of right upper quadrant discomfort and 1 case of residual gallstones. Conclusion Due to the high-definition vision and good sense of depth, it is safe and effective in gallbladder resection with 3D laparoscopy. 3D laparoscopy may help reduce intraoperative blood loss, shorten operative time, and is worthy of clinical application.