Comparative Study On The Dissection Of The Triangle Of The Gallbladder With A Common Aspirator And An Ultrasonic Knife During Laparoscopic Cholecystectomy

ObjectiveIn the operation of laparoscopic cholecystectomy,using common attractor blunt separation gallbladder triangle,use of the advantages of laparoscopic look straight sex,and analyze the cystic artery with a normal physiological anatomy and the variation of the cystic duct,to prevent the occurrence of gallbladder artery injury bleeding during surgery or bile duct injury,and compared the attractor combined ultrasonic knife set of intraoperative and postoperative recovery index,summarized the safety and feasibility of blunt separation of gallbladder triangle with common aspirator.Methods178 cases of patients undergoing laparoscopic cholecystectomy in our department were investigated and divided into control group and observation group according to the principle of random allocation,with 89 cases in each group.The control group was separated and dissected by ultrasonic knife,while the observation group was dissected by blunt dissection of Calot triangle with the ordinary aspirator.The gallbladder triangle was dissected carefully in both groups,and the gallbladder artery and duct were dissected.The surgical indexes and postoperative recovery of the two groups were compared and analyzed.Results1.In the operation of the two groups of patients,all carefully dissect Calot triangle,free gallbladder artery,and the analysis concluded that the four types of the gallbladder artery were cholecystic artery absence and single,double and multiple branches.The proportions of these four types were single branch type 112 cases(62.92%),double branch type 42 cases(23.60%),multiple branch type 22 cases(12.36%)and cholecystic artery absence 2 cases(1.12%).2.Among the 112 patients with single-branch cystic,91 patients(81.25%)went through the Calot triangle,and 21 patients(18.75%)did not go through the cystic triangle.Among the 42 patients with double-branch cystic arteries,11 cases(26.19%)passed through the cystic triangle,among which 30 cases(71.43%)passed through the cystic triangle,and 1 case(2.38%)did not pass through any branch of the cystic artery.3.Among the 112 cases of single cystic artery in this study,the cystic artery entered the gallbladder from the medial side of the cystic duct in 91 cases,entered the gallbladder through the posterior side of the cystic duct in 10 cases,entered the gallbladder through the anterior side of the gallbladder in 8 cases,and entered the gallbladder through the lateral side of the cystic duct in 3 cases.4.Among the 112 cases in this study,65 cases(58.03%)of the cystic artery originated from the gallbladder triangle;30 cases(26.79%)originated from the front of the common hepatic duct or common bile duct,and 17 cases(15.18%)originated from other parts.5.The amount of blood loss and abdominal drainage rate in the observation group were 47.40±0.52 ml,58 cases(65.17%),and the amount of blood loss and abdominal drainage rate in the control group were 48.82±0.70 ml,57 cases(64.04%),respectively,P > 0.05,the difference was not statistically significant.Observation group of patients with operation time,anatomy of gallbladder triangle time and rate of bile duct injury are: 46.83±0.47 min and 12.22±0.21 min,0 cases,control group patients in the surgery time,anatomy of gallbladder triangle and bile duct injury rate is respectively: 55.75±1.05 min and 18.92±0.39 min,4 cases(4.49%),biliary injury observation group patients were significantly lower than the control group,P < 0.05,with statistical significance.6.The postoperative abdominal drainage time of the observation group was38.14±0.58 h,and that of the control group was 39.50±0.66 h,P > 0.05,the difference was not statistically significant.Observation group of patients with postoperative gastrointestinal function recovery time,incidence of bile leakage,such confinement,postoperative infection were 27.45±0.41 h,0 cases,6.27±0.11 d,1 case(1.12%)and control group in patients with postoperative gastrointestinal function recovery time,incidence of bile leakage,such confinement,postoperative infection were 30.18±0.63 h,5 cases(5.62%),6.93±0.15 d,7 cases(7.87%),the observation group significantly lower than the control group,P < 0.05,differences were statistically significant.ConclusionIn laparoscopic cholecystectomy,the study summarized the branches,origin,course and various types of variation of the cystic artery during the operation,to provide a reference for clinical operation.This paper also studied the general aspirator blunt separation gallbladder triangle,free gallbladder artery,and,in comparison with conventional ultrasonic knife anatomy of gallbladder triangle adopts the aspirator’s anatomy of gallbladder triangle favorable operation,not only reduce the operation time,reduce the incidence rate of injury of vice,more can effectively reduce the incidence of postoperative bile leakage and infection,feasibility and high security,is worth promoting and application in the clinical practice.