改良式单孔腹腔镜与传统腹腔镜胆囊切除术临床对比研究

目的通过对改良式经脐入路单孔腹腔镜胆囊切除术(transumbilical single-port laparoscopic cholecystectomy,TSPLC)与传统腹腔镜胆囊切除术(LC)的临床效果对比,研究改良式经脐单孔腹腔镜胆囊切除术在临床应用的安全性、优越性及技术要点。方法回顾性分析我院2014年9月至2016年5月行LC的98例患者(经脐单孔LC组为50例,传统三孔LC组为48例)的临床资料,分别观察并对比两组手术时间、术中出血量、术后疼痛评分、术后止痛药物的使用率、住院时间、切口并发症及切口满意度。结果两组患者均成功完成手术;经脐单孔组手术时间(65.7±13.6)min,传统三孔组(40.2±9.8)min,两者差异有统计学意义(P0.01);经脐单孔组术后6 h疼痛评分(3.83±1.73)及术后止痛药物使用率(8%)均明显低于传统三孔组术后6 h疼痛评分(4.02±7.5),P=0.025;止痛药物应用率(31.25%),P0.01]。术后患者对切口的满意度,经脐单孔组(95.3±10.78)明显高于传统三孔组(78.57±12.65)(P0.01)。两组术中出血量、术后24 h疼痛评分及术后住院时间比较均无统计学差异(P0.05)。术后随访2~3个月,无胆漏、出血、腹腔积液、切口感染等并发症发生。结论使用改良式经脐入路单孔腹腔镜胆囊切除术安全可行,与传统LC相比具有更加美观、微创,术后恢复快,术后疼痛轻等诸多优势,且不增加手术风险;但该手术操作难度较大,学习曲线相对较长,有一定腹腔镜手术经验的外科医师才能完成。

Clinical comparative study on modified transumbilical single-port laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy

Objective To study the safety, superiority, technical points of modified transumbilical single-port laparoscopic cholecystectomy through comparison with the conventional laparoscopic cholecystectomy (LC). Methods Retrospective analysis method was used to collect the clinical data of 98 patients undergone LC in our hospital from Sep. 2014 to May 2016. Patients were divived into two groups: transumbilical single-port LC group (n=50) and traditional three-port LC group (n=48). The operation duration,intraoperative blood loss, pain scores, rate of needing postoperative analgesic drugs, hospitalization duration, wound complications rate and incision satisfaction comparison between two groups were compared.Results There was no clinical statistical difference between two groups before operation (P>0.05). All the operations were successfully completed in two groups. For transumbilical single-port LC group, the operation duration was longer than traditional three-port LC group (P<0.01); pain scores at postoperative 6 h, rate of needing postoperative analgesic drugs were also significantly lower than those in the traditional three-port LC group (P=0.02;P<0.01), and wound complication rate was significantly higher than that in traditional three-port group (P<0.01). There were no significant differences in in-traoperative blood loss, pain scores at postoperative 24 h, hospitalization duration between two groups (P>0.05). After 2~3 months follow-up, no postoperative complication (hemorrhage, cholerrhagia and biliary duct damage) was found.Conclusion Modified transumbilical single-port laparoscopic cholecystectomy is safe and feasible. Compared with conventional three-port LC, it has the advantage of more beautiful, less invasive, faster postop-erative recovery, less postoperative pain, and no increasing the surgery risk. Due to more surgery difficulty and longer learning curve, modified transumbilical single-port laparoscopic cholecystectomy is suitable for surgeon with certain experience on laparoscopic surgery.