脐部双套管技术经脐入路腹腔镜胆囊切除术26例

目的探讨脐部双套管技术经脐入路内镜手术（transumbilical endoscopic surgery，TUES）胆囊切除术的可行性。方法26例胆囊疾病（胆囊息肉样病变5例，结石21例）行TUES胆囊切除术。沿脐下缘做横行切口，建立气腹后于切口两侧置入2只5mm操作套管。分别置入5mm腹腔镜和操作器械。于右肋下置入直径2mm抓钳用于协助牵引胆囊。用普通腹腔镜器械和超声刀完成胆囊切除。结果除1例因术中出血中转常规腹腔镜手术外，余25例手术成功。25例成功者手术时间25—50min，平均35min。均未放置引流。无出血、胆漏等并发症发生。除脐部皱褶部位外，基本无可见的腹壁瘢痕。结论双套管技术经脐入路胆囊切除术操作简单、安全，技术上是可行的。同常规腹腔镜手术相比，TUES胆囊切除难度仍较大，在开展TUES手术初期应慎重选择病例。

Double Trocar Transumbilical Endoscopic Cholecystectomy: Report of 26 Cases

Objective Owing to limitations in issues of access, tissue manipulation, and secure tissue approximation/ closure, natural orifice transluminal endoscopic surgery （NOTES） has been developed slowly over the years. In this study, we employed a new approach, transumbilical endoscopic surgery （TUES） to treat 26 patients with gallbladder diseases. Methods A total of 26 patients including 21 cases of gallbladder stone and 5 cases of polyps underwent TUES cbolecystectomy in our hospital. Two 5-mm trocars were placed through an infra-umbilicus incision. A mini grasper was placed at the right upper abdomen to grasp the fundus of gallbladder, so that the gallbladder can be dissected and removed by using conventional laparoscopic instruments. Results The operation was completed in all the cases except in one, who was converted to conventional laparoscopic surgery because of intraoperative bleeding. The operation time was between 25 and 50 minutes with a mean of 35 minutes. No postoperative bleeding or bile leakage occurred in this group of patients. Satisfying cosmetic results were achieved on the abdomen. Conclusions Double trocar transumbilical endoscopic cbolecystectomy is feasible, and is simpler and safer than NOTES technique. Patients should be carefully selected at the beginning stage.