经胆囊板入路行腹腔镜困难胆囊切除术在基层医院的应用效果OA

Objective To explore the application clinical efficacy of laparoscopic difficult cholecystectomy via the cystic plate approach(CPA).Methods A retrospective analysis was conducted on the clinical data of 74 patients who underwent laparoscopic difficult cholecystectomy at Xixian People's Hospital,Henan Province,from January 2023 to June 2024.Among them,25 patients underwent laparoscopic difficult cholecystectomy via the CPA(CPA group),and 49 patients underwent laparoscopic difficult cholecystectomy via the conventional approach(conventional group).After propensity score matching(PSM)with covariates including age,gender,body mass index(BMI),gallbladder wall thickness,and acute-phase surgery,24 patients were allocated to each group for comparative analysis.Results After PSM,no statistically significant differences were observed in baseline characteristics between the two groups(P>0.05).Compared to the conventional group,the CPA group demonstrated a lower incidence of intraoperative blood loss exceeding 20 mL[8.3%(2/24)vs 33.3%(8/24),χ2=4.547,P=0.033],shorter operation time[56.0(40.0,67.0)min vs 64.5(58.5,85.75)min,Z=-2.193,P=0.028],and less total hospitalization costs[8 173.5(7 453.8,9 015.8)CNY vs 9 954.2(7 029.8,10 241.5)CNY,Z=-2.248,P=0.025].There were no statistically significant differences between the two groups in preoperative C-reactive protein levels,rates of accidental gallbladder injury,or postoperative white blood cell counts(P>0.05).Conclusion Laparoscopic difficult cholecystectomy via the CPA is safe,practical,and does not have technical barriers in primary hospital.Compared to the conventional approach,it can reduce intraoperative blood loss and operation time,thereby shortening the hospital stay and reducing medical expenses.