Comparsions Of Laparoscopic Cholecystectomy With The Three Hole Method Of Abdominal Wall Puncture Retractor Or Traditional Four Hole Method

Objective: To study the clinical effects of laparoscopic cholecystectomy(LC)with the three hole method of abdominal wall puncture retractor or traditional four hole method in common and complex LCs.Methods: A total of 60 consecutives suitable for the experiment were enrolled from January 2015 to December,they were divided according to the suggestions that common LCs including gallbladder stones,gallbladder polyps,chronic cholecystitis were divided into the two groups by the random number method,and complex LCs including upper abdominal surgery history,primary peritonitis,combined with cirrhosis,atrophic cholecystitis were divided into the two groups by the random number method;then each of the three hole and four hole groups were 30 cases.The characteristics including gender,age,course of diseases,body mass index,proportion of common and complex LCs,rates of hypertension,diabetes and heart disease,levels of serum alanine aminotrans-ferase,creatinine,total bilirubin and albumin in the two groups were no statistical difference.The operations were executived by the same treatment group according to standard medical procedures.The observated indicators including operative success rate and complications rate;mean operative time,intraoperative and postoperative bleeding volume,drainaged volume,gastrointestinal function recovery time and postoperative in-hospital days;pain degree(VAS value)6h,12 h and 24 h after operation;nausea,vomiting grades and fatigue score during 24h;immune and inflammatory response indicators before and three days,seven days after operation including proportions of CD3+,CD4+,CD8+ T cells and CD4+/ CD8+,levels of serum CRP,IL-6,TNF-? and cortisol(Cor),immunoglobulin A(IgA),IgG and IgM;the score of abdominal wall cosmetic satisfactory degrees,the gastrointestinal disease quality of life index(GIQLI)and health-related quality of life scale(SF-36)as the health status assessment.Results: The operative success rate and complications(including incision and abdominal infections,bile leakage,bile duct injury,vascular and nerve injuries and hepatorenal dysfunction)rate were in the two groups were no statistical difference(P>0.05).The mean operative time,intraoperative and postoperative bleeding volume and drainaged volume were in the two groups were no statistical difference(P>0.05),while the gastrointestinal function recovery time and postoperative in-hospital days in three hole group were both significantly shorter than four hole group(P<0.05).The VAS values after 6h,12 h and 24 h in three hole group were all significantly lower(P<0.05).The vomiting grades and fatigue score in three hole group were less(P<0.05).The immune and inflammatory response indicators in the two groups were all no statistical difference(P>0.05).The score of abdominal wall cosmetic satisfactory degrees in three hole group was significantly higher(P<0.05).And the GIQLI and SF-36 scroes were also higher than four hole group(P<0.05).Conclusion: The three hole method with abdominal wall puncture retractor than traditional four hole method could furtherly reduce trauma and pain,promote postoperative rehabilitation in patients with common and complex LCs.