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接受谐波刀腹腔镜胆囊切除术患者的治疗结果

The Outcomes of the Patients Undergoing Harmonic Scalpel Laparoscopic Cholecystectomy.

作者信息

Kannan Amudhan, Tara Anjli, Quadir Huma, Hakobyan Knkush, Gaddam Mrunanjali, Ojinnaka Ugochi, Ahmed Zubayer, Dominic Jerry Lorren, Kantamaneni Ketan, Went Terry R, Mostafa Jihan A

机构信息

General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.

General Surgery, Stony Brook Medicine, Southampton Hospital, Southampton, USA.

出版信息

Cureus. 2021 Jun 13;13(6):e15622. doi: 10.7759/cureus.15622. eCollection 2021 Jun.

Abstract

Laparoscopic cholecystectomy has replaced conventional open cholecystectomy and has become the gold standard surgery for gall bladder pathologies. The harmonic scalpel is one of the instruments used to dissect and coagulate. Most surgeons accept the usage of the harmonic scalpel in laparoscopic cholecystectomy. The other standard method is electrocoagulation by electrocautery. The harmonic scalpel cholecystectomy has several advantages over other methods of laparoscopic cholecystectomy. Electrocoagulation by electrocautery produces smoke which can result in damage to lateral tissues, including the gall bladder. The clips are used along with electrocoagulation to seal cystic duct and cystic artery before dissection. There are various studies about bile leakage in the case of clip application. The harmonic scalpel uses ultrasonic energy to achieve hemostasis without bleeding, dissection, and gallbladder removal from the liver bed during laparoscopic surgery by causing coagulation of proteins. The patient outcome variables such as postoperative pain, duration of hospital stay, postoperative nausea and vomiting, surgical site infections, and other complications have not been compared in review articles. In this review, we collected the information from previously published studies and reviewed the outcomes of patients undergoing harmonic scalpel cholecystectomy. Harmonic scalpel cholecystectomy reduces the duration of hospital stay, duration of operation, intraoperative and postoperative complications, and postoperative pain. Thus the harmonic scalpel can be used instead of other instruments as it has better patient outcomes.

摘要

腹腔镜胆囊切除术已取代传统的开腹胆囊切除术,成为胆囊疾病的金标准手术。超声刀是用于解剖和凝血的器械之一。大多数外科医生认可在腹腔镜胆囊切除术中使用超声刀。另一种标准方法是电灼电凝。与其他腹腔镜胆囊切除术方法相比,超声刀胆囊切除术有几个优点。电灼电凝会产生烟雾,可能导致包括胆囊在内的周围组织受损。在解剖前,夹子与电凝一起用于封闭胆囊管和胆囊动脉。关于夹子应用导致胆汁漏的情况有各种研究。超声刀利用超声能量在腹腔镜手术期间通过使蛋白质凝固来实现止血,同时进行解剖并将胆囊从肝床移除。综述文章中尚未对术后疼痛、住院时间、术后恶心和呕吐、手术部位感染及其他并发症等患者结局变量进行比较。在本综述中,我们收集了先前发表研究中的信息,并回顾了接受超声刀胆囊切除术患者的结局。超声刀胆囊切除术可缩短住院时间、手术时间、减少术中及术后并发症以及减轻术后疼痛。因此,由于超声刀对患者有更好的结局,可替代其他器械使用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d295/8275056/f34dc6279daa/cureus-0013-00000015622-i01.jpg

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