经脐单孔腹腔镜胆囊切除术与经典腹腔镜胆囊切除术的疗效比较

目的 比较经脐单孔腹腔镜胆囊胆囊切除术(TU-LESS)与经典腹腔镜胆囊切除术(LC)的手术效果.方法 对我院2009年5月至2010年6月间经筛选符合纳入标准的66例患者随机分为两组,33例行TU-LESS,33例行LC,比较两组手术时间、术中出血量、术中并发症、术后排气、术后镇痛药物应用、术后胃肠功能恢复时间、切口感染、术后住院时间等多项指标.结果 TU-LESS组在术后排气、术后镇痛药物应用、术后胃肠功能恢复时间及术后住院时间等明显优于LC组(P<0.01),但手术时间LC组明显长于TU-LESS组(P<0.01),两组在切口感染、术中出血量及术中并发症方面无明显的差异(P>0.05).结论 经脐单孔腹腔镜手术,具有传统腹腔镜手术的优点,术后疼痛轻、恢复快、住院时间短、更加微创的技术及无疤痕效果是传统腹腔镜手术不具备的,但因TU-LESS手术难度较LC明显增高,故早期开展手术时间明显延长,且术前需经过严格的筛选,以保证手术的安全性.     

腹腔镜与小切口胆囊切除术再比较体会

目的 :比较腹腔镜胆囊切除术 (LC)与小切口胆囊切除术 (MC)的适应证、安全性及临床效果。方法 :对比研究MC 86例与同期开展的LC 86例。结果 :两组的手术时间无明显差异 (P >0 0 5 ) ,手术出血量、术后恢复时间和住院时间LC组少于MC组 (P <0 0 1)。结论 :LC适应证广、安全性高 ,在创伤小、痛苦少和恢复快等方面优于MC。     

小切口胆囊切除术与腹腔镜胆囊切除术的疗效分析

自 1998年 2月至 1999年 10月间 ,我们同期进行ＭＣ与ＬＣ并对比观察 ,现报告如下。1　材料和方法1.1　一般资料　将 2 0 3例结石性胆囊炎病人随机分为ＭＣ组与ＬＣ组。ＭＣ组 10 5例 ,男 41例 ,女 6 4例 ,年龄 2 2～ 78岁 ,病史最长 40年。ＬＣ组 98例 ,男 43例 ,女 5 5例 ,年龄 2 3～ 73岁 ,病史最长 41年。1.2　手术方法　ＭＣ组硬膜外麻醉 ,经右上腹直肌切口 5～6ｃｍ ,逐层进腹 ,在胆囊下方及左右侧分别填入小纱垫 ,用两把小号Ｓ拉钩显露胆囊及Ｃａｌｏｔ三角。用多功能刀括吸法解剖出胆囊管及胆囊动脉 ,分别用钛夹钳持钛夹夹闭胆囊管…     

小切口胆囊切除术与腹腔镜胆囊切除术比较分析

目的:比较小切口胆囊切除术(MC)及腹腔镜胆囊切除术(LC)治疗胆囊疾病的临床疗效,评价两种术式的特点及优势。方法:选择46例胆囊疾病患者,随机分为例数相等的观察组与对照组,观察组采用MC,对照组采用LC。对两组手术时间、肠蠕动恢复时间、住院时间进行比较分析。结果:观察组在手术时间、肠蠕动恢复时间及住院时间方面与对照组不存在统计学差异(P>0.05),但MC的住院费用较低,两组间差异有统计学意义(P<0.01)。结论:MC用于胆囊疾病的治疗,具有与LC相近的疗效,但MC的费用较低,易于在基层医院推广,具有临床应用价值。     

比较腹腔镜胆囊切除术与小切口胆囊切除术的效果

目的比较小切口胆囊切除术(MC)与腹腔镜胆囊切除术(LC)治疗胆囊结石的效果。方法根据不同术式将接受手术的78例胆囊结石患者分为2组。MC组38例行MC,LC组40例实施LC。比较2组的治疗效果。结果 2组患者的手术时间、术中出血量和术后疼痛VAS评分、下床活动时间、肛门排气时间及住院时间比较,差异无统计学意义(P0.05)。但MC组的住院费用显著低于LC组,差异有统计学意义(P0.05)。结论 MC与LC治疗胆囊结石具有相同良好的疗效,但MC的治疗费用低廉。应在严格把握手术适应证的前提下,根据患者的病情、经济条件、医院设备和医生技术水平等因素综合分析,个体化选择术式。     

腹腔镜胆囊切除术与开腹胆囊切除术的比较

按顺序抽取腹腔镜胆囊切除术(LC)病历110份，开腹胆囊切除术(OC)病历136份，笔者就两组病例的手术时间、切口长度、出血量及住院天数等资料进行回顾性分析和比较，结果显示：LC组在手术时间、切口长度、出血量及住院天数均短于或少于OC组。提示：LC优于OC，值得在基层推广与普及。     

小切口胆囊切除术与腹腔镜胆囊切除术比较分析

目的比较小切口胆囊切除术(MC)与腹腔镜胆囊切除术(LC)2种术式的特点。方法对比研究24例MC与同期开展的2，4例LC临床资料。结果两组的手术时间、肠蠕动恢复时间及住院时间差异无显著性，但在医疗费用上LC明显高于MC。结论MC与LC微创程度相近，但MC对Calot三角操作直接，安全，且费用低，更易于在基层医院推广应用。     

单切口腹腔镜胆囊切除术与腹腔镜胆囊切除术的病例对照研究

目的回顾性分析单切口腹腔镜胆囊切除术（SILC）与传统腹腔镜胆囊切除术（LC）的优劣性。方法19例SILC及46例LC患者的临床资料,比较两者的手术时间、术中出血量、术后并发症、中转率、术后疼痛、住院时间、切口长度的差异。结果SILC手术耗时（49．00±8．34）min长于LC（P=0．000）。术中出血量差异无统计学意义。两组均无中转、术后无并发症;SILC与Lc术后患者第一天疼痛评分、术后第三天疼痛评分、总疼痛天数差异均无统计学意义。两者住院时间差异无统计学意义。SILC切口长度（22．5±3．5）mm短于LC切口长度（P=0．000）。结论SILC总切口长度短于LC总切口长度,切口效果更美观。SILC能安全地用于单纯胆囊结石、胆囊息肉。同时对于没有严重合并症和腹部手术史的胆囊疾病患者SILC也是一种理想的手术选择。     

经脐单孔与常规腹腔镜胆囊切除术的对比研究

目的比较经脐单孔腹腔镜胆囊切除术（TUSPLC）与常规腹腔镜胆囊切除术（LC）的临床疗效。方法回顾性分析2010年5月至2010年10月确诊为无严重胆囊炎症的胆囊息肉或胆囊结石患者共56例,随机分为单孔组和常规组,比较两组手术时间、术中出血量、术后镇痛、术后住院时间及术后并发症。结果单孔组26例患者23例顺利完成手术,3例中转改LC;常规组30例患者均顺利完成手术。单孔组与常规组手术时间分别为（52.45±10.84）min和（39.29±8.61）min（t=5.0601,P=0.0000）,术中出血量分别为（19.32±5.69）ml和（22.17±6.27）ml（t=1.7703,P=0.0823）;术后需镇痛分别为1例和6例（χ2=0.0702,P=0.7910）;术后住院时间分别为（2.52±1.37）d和（2.57±1.16）d（t=0.7396,P=0.4628）。除手术时间两组有明显差异外（P〈0.05）,余两组观察指标差异均无统计学意义（P〉0.05）。两组均无出血、胆漏、胆管损伤等并发症发生。结论经脐单孔腹腔镜胆囊切除术与常规腹腔镜胆囊切除术一样安全、可行,具有瘢痕不明显且隐避,术后患者疼痛轻、恢复快等优点,在胆囊切除中占有一席之地。但对患者技术和设备要求较高。     

改良隐瘢痕腹腔镜与单孔腹腔镜胆囊切除术对比研究

目的 探讨改良经脐及白线隐瘢痕腹腔镜胆囊手术的临床疗效及应用价值.方法 回顾性分析2011年6月至2013年5月江西省宜丰县人民医院收治的胆囊结石患者193例,随机分为二组,观察组行改良经脐及白线隐瘢痕腹腔镜胆囊手术,对照组行常规单孔法腹腔镜手术.对比分析二组患者手术时间、术后切口疼痛程度、术后切口满意程度及中转率.结果 观察组比对照组手术时间短,差异有统计学意义（t=14.72,P＜0.000 1）.观察组术后1 d切口疼痛程度明显轻于对照组（t=11.42,P＜0.000 1）;术后2 d切口疼痛程度差异无统计学意义（t=1.26,P=0.10）.术后患者切口满意程度差异无统计学意义（t=1.51,P=0.067）;对照组有3例中转手术.二组均无胆管损伤、术后出血、胆漏等并发症发生.结论 改良经脐及白线隐瘢痕腹腔镜胆囊手术安全、可行,不需要特殊器械,术后瘢痕不明显且隐蔽,手术难度不高,术后患者切口满意度高,是一种美观、安全的腹腔镜手术新途径,适合在基层医院推广.     

传统术式,腹腔镜与小切口胆囊切除术疗效对比研究

为探讨小切口胆囊切除术的临床价值,作者就传统开腹胆囊切除术３００例（Ａ组）、腹腔镜胆囊切除术３００例（Ｂ组）、与小切口胆囊切除术３００例（Ｃ组）的手术时间、术中出血量、并发症、术后胃肠功能恢复时间、输液天数和住院天数等项指标进行了对比。结果显示：Ａ组手术时间、术中出血量、输液天数、胃肠功能恢复时间及住院天数比Ｂ、Ｃ两组长（Ｐ＜０．０５）。Ｂ、Ｃ两组的手术时间、术中出血量、胃肠功能恢复时间、输液天数及住院时间相近似。并发症发生率Ａ组（０．３３％）比Ｂ组（１．６６％）低,而Ｃ组未出现１例并发症（Ｐ＜０．０５）。综合三组疗效对比,Ｃ组明显优于Ａ、Ｂ两组。     

完全经脐单切口腹腔镜胆囊切除术13例报告

目的:探讨完全经脐单切口腹腔镜胆囊切除术在基层医院的可行性及技术改进.方法:回顾分析为16例患者施行经脐单切口腹腔镜胆囊切除术的手术方法及临床效果,并总结分析国内相关文献.结果:1例因可疑胆囊癌中转开腹,2例因腹腔粘连等因素增加切口完成腹腔镜胆囊切除术.手术时间30~90 min.成功开展的13例术后无出血、胆漏等并发...     

单切口与传统腹腔镜胆囊切除术的随机对比研究

目的:对比分析单切口腹腔镜胆囊切除术(single-incision laparoscopic cholecystectomy,SILC)与传统四孔法腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的近期疗效。方法:2011年6月至8月将40例胆囊结石和胆囊息肉患者随机分为SILC组(n=20)和LC组(n=20)。对比分析两组患者一般资料、手术时间、术中出血量、术后住院时间、并发症、切口长度、疼痛程度和C反应蛋白量(C-reactive protein,CRP)。结果:两组患者年龄、性别、ASA分期、体重指数和术前CRP无明显差别,手术时间、术中出血量、术后住院时间、并发症、术后CRP差异无统计学意义,但SILC组切口更小,术后疼痛更轻微。结论:适当把握手术适应证,SILC安全可行,具有切口长度小、术后疼痛轻等优点。     

经脐单孔腹腔镜与传统腹腔镜胆囊切除术的对比研究

目的：探讨现阶段经脐单孔腹腔镜胆囊切除术（laparoscop ic cholecystectomy,LC）的安全性、可行性及优势。方法：回顾分析山东大学齐鲁医院开展的经脐单孔LC（A组,n=12）及同期完成的传统LC（B组,n=23）的临床资料。对比两组手术时间、术中出血量、术后住院时间、并发症发生率及总住院费用等指标。结果：35例手术均获成功,术后无并发症发生。两组术中出血量差异无统计学意义（P〉0.05）,经脐单孔LC组术后住院时间及总住院费用明显优于传统LC组（P〈0.01）,而传统组手术时间则优于经脐单孔组（P〈0.01）。在经脐单孔组组内对比发现,手术时间随手术量的增加有逐渐减少的趋势,其中后4例手术时间明显少于前4例（P〈0.01）。结论：目前经脐单孔LC是安全可行的,术后住院时间及总住院费用明显优于传统LC,具有成为一定时期内主流LC的潜力。     

Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data

Background

This study presents preliminary data from a prospective randomized multicenter, single-blinded trial of single-incision laparoscopic cholecystectomy (SILC) versus standard laparoscopic cholecystectomy (4PLC).

Methods

Patients with symptomatic gallstones, polyps, or biliary dyskinesia (ejection fraction <30%) were randomized to SILC or 4PLC. Data included operative time, estimated blood loss, length of skin and fascial incisions, complications, pain, satisfaction and cosmetic scoring, and conversion.

Results

Operating room time was longer with SILC (n = 50) versus 4PLC (n = 33). No differences were seen in blood loss, complications, or pain scores. Body image scores and cosmetic scores at 1, 2, 4, and 12 weeks were significantly higher for SILC. Satisfaction scores, however, were similar.

Conclusions

Preliminary results from this prospective trial showed SILC to be safe compared with 4PLC although operative times were longer. Cosmetic scores were higher for SILS compared with 4PLC. Satisfaction scores were similar although both groups reported a significantly higher preference towards SILC.     

Large subcapsular liver hematoma following single-incision laparoscopic cholecystectomy

Background and Objectives:

Many laparoscopic surgeons are now transitioning from standard multiple-port laparoscopic cholecystectomy to single-incision laparoscopic surgery (SILS) in an attempt to improve cosmetic outcomes and decrease postoperative morbidity. However, little has been published regarding the potential complications of SILS operations.

Methods:

We report the case of a patient undergoing SILS cholecystectomy who developed the complication of a large hepatic hematoma, resulting in significant postoperative morbidity, blood transfusion requirement, and reoperation.

Results:

After an in-depth internal review of the postoperative morbidity of this case, it appears that the causative factor may be instrument shaft torque on the liver surface.

Conclusion:

Single-incision laparoscopic surgery may pose significant and unique risks that warrant additional operative caution. Quantitative comparison of SILS to the gold-standard laparoscopic cholecystectomy is needed to further elucidate definitive benefits and complications of this novel technique.     

Single-incision laparoscopic cholecystectomy in children: a retrospective comparison with traditional laparoscopic cholecystectomy

Purpose

The natural progression of minimal access surgery is to perform the same technical operation with minimal or no evidence of scarring. In children, small case series of single-incision laparoscopic cholecystectomy suggests that the operation is feasible; however, no comparison has been made to traditional, multiport laparoscopic cholecystectomy in patient safety, outcomes, and cost.

Methods

A retrospective review of consecutive single-incision laparoscopic cholecystectomies in children was performed from January 2009 to November 2010. Demographics and outcome measures were recorded, including operative time, operative costs, length of stay, need for intravenous analgesia, and operative complications. A concurrent group of pediatric patients undergoing traditional, multiport laparoscopic cholecystectomy was used for comparison.

Results

A total of 69 pediatric laparoscopic cholecystectomies were performed from January 2009 to October 2010. Forty-two patients with a mean age of 14.7 years (range, 5.9-18.9 years) underwent attempted single-incision laparoscopic cholecystectomy, and 27 patients with a mean age of 15 years (range, 2.8-19.4 years) underwent multiport laparoscopic cholecystectomy. Mean operative time (68 vs 64.5 minutes; P, not significant [NS]), length of stay (1.45 vs 1.19 days; P, NS), and doses of intravenous analgesia (1.7 vs 2; P, NS) were not significantly different for patients undergoing single-incision or multiport laparoscopic cholecystectomy, respectively. Two patients (5%) undergoing the single-incision approach required 1 additional port be placed to complete the operation. In addition, there was no significant difference in operative costs between the single-incision and multiport approach ($7766 vs $8383; P, NS).

Conclusion

Single-incision laparoscopic cholecystectomy is safe and effective in the pediatric population. It can be performed with the same technical exposure and outcomes as multiport laparoscopy, with the added benefit of little to no scarring and no increase in cost.     

单孔与三孔腹腔镜胆囊切除术的对比研究

目的：评价经脐单孔腹腔镜胆囊切除术的安全性和可行性。方法：回顾分析为66例患者行腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的临床资料,33例行经脐单孔LC（单孔组）,33例行三孔法LC（三孔组）。主要评价指标包括：术中及术后并发症、术后疼痛程度、中转开腹率;次要指标包括：手术时间、术中估计出血量、手术难易度、开始进食时间及术后住院时间。结果：两组的主要指标及次要指标差异均无统计学意义。结论：经脐单孔LC可取得与三孔法相同的临床结果,此术式是安全可行的。     

Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy

Background

This study aimed to compare the outcomes of single-incision laparoscopic cholecystectomy (SILC) versus conventional 4-port laparoscopic cholecystectomy (LC).

Methods

From November 2009 to August 2010, 51 patients with symptomatic gallstone or gallbladder polyps were randomized to SILC (n = 24) or 4-port LC (n = 27).

Results

Mean surgical time (43.5 vs 46.5 min), median blood loss (1 vs 1 mL) and mean hospital stay (1.5 vs 1.8 d) were similar for both the SILC and 4-port LC group. There were no open conversions and no major complications. The mean total wound length of the SILC group was significantly shorter (1.76 vs 2.25 cm). The median visual analogue pain score at 6 hours after surgery was similar (4.5 vs 4.0) but the SILC group had a significantly worse pain score on day 7 (1 vs 0). There was no difference in time to resume usual activity (mean, 5.6 vs 5.0 d). The median cosmetic score of SILC was significantly higher than at 3 months after surgery (7 vs 6).

Conclusions

SILC was feasible and safe for properly selected patients in experienced hands.