日间单孔腹腔镜胆囊切除术在巨大胆囊结石、肥胖及老年患者中的应用效果OA

Objective To analyze the application value and clinical efficacy of ambulatory single-incision laparoscopic cholecystectomy(SILC)in giant gallstones,obesity and elderly patients.Methods Clinical data of 1 596 patients who underwent ambulatory laparoscopic cholecystectomy(ALC)at Sichuan Provincial People's Hospital from January to December 2023 were retrospectively analyzed.After excluding 43 patients who withdrew from the ambulatory pathway,1 553 patients were finally divided according to surgical procedure into the SILC group(n=775)and the traditional three-port laparoscopic cholecystectomy(TPLC)group(n=778).Intraoperative and postoperative data were compared between the two groups to evaluate the clinical efficacy of SILC in the ambulatory setting.Additionally,subgroup analyses were performed based on gallstone diameter≥3 cm(the giant gallstone subgruop),body mass index(BMI)≥30 kg/m2(the obesity subgroup),and age≥65 years(the elder subgroup).Operative time,postoperative visual analogue scale(VAS)pain scores,and postoperative complications were assessed to explore the safety and efficacy of SILC in these special populations.Results There were no statistically significant differences between the two groups in intraoperative blood loss,operative time,or overall complication rate(P>0.05).However,the SILC group had significantly lower postoperative VAS pain scores[3(2,4)vs 5(4,6),P<0.001].Subgroup analysis showed that patients with giant gallstones,the SILC group had shorter operative time[(55.18±9.41)min vs(57.85±9.03)min,P=0.023]and significantly lower postoperative VAS pain scores[3(2,4)vs 5(4,6),P<0.001].Among obese and elderly patients,there was no significant difference in operative time between the two groups(P>0.05),but the SILC group had consistently lower VAS pain scores than the TPLC group[the obesity subgroup:3(2,4)vs 5(5,6);the elder subgroup:3(2,4)vs 5(5,6);all P<0.001].No statistically significant differences in complication rates were observed in any subgroup(P>0.05).Conclusion Both ambulatory SILC and TPLC are safe and feasible.SILC not only enhances surgical efficiency in patients with giant gallstones but also optimizes postoperative pain management across various special populations while ensuring the safety of minimally invasive surgery.Therefore,after rigorous assessment of patient baseline conditions,SILC can be considered a preferred option for ambulatory cholecystectomy in special populations including those with giant gallstones,obesity,and elder.