经脐单一切口腹腔镜胆囊切除术：附35例报告

目的探讨经脐单一切口腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的可行性及安全性。方法2010年3月～2011年8月行经脐单一切口LC 35例。脐孔左缘做弧形3 cm开放切口,置入2.5 cm三通转换器,经三通转换器中孔置入5 mm腹腔镜,右孔置入10 mm弯曲操作钳作为主操作孔,左孔置入5 mm弯曲操作钳作辅助操作孔。解剖分离胆囊动脉、胆囊管,钛夹或可吸收夹处理胆囊管及胆囊动脉。将胆囊自肝床分离,切除胆囊,自3cm开放切口取出胆囊。结果2例因胆囊颈部结石嵌顿,胆囊三角解剖困难,中转开腹;33例顺利完成LC。手术时间45～125 min,平均65 min。术中出血量5～200 ml,平均20 ml。35例随访3～20个月,平均10个月,无术后大出血、胆漏等并发症发生。结论经脐单一切口LC操作可行、安全,美容效果明显。

Transumbilical Single-port Laparoscopic Cholecystectomy: Report of 35 Cases

Objective To study the feasibility and safety of transumbilical single-port laparoscopic cholecystectomy （TSLC）. Methods The clinical data of 35 patients, who underwent TSLC in our hospital from March 2010 to August 2011, were retrospectively analyzed. A 3-cm curve incision was made on the left edge of the umbilicus, so that to insert one 2.5-cm 3-hole adaptor, through which we placed a 5-mm pliable grasper in the middle hole, 10-mm bending forceps in the right hole, and 5-mm bending forceps in the left. The cystic artery and duct were separated, and then blocked with titanium or absorbable clips, so that to remove the gallbladder through a 3-cm incision on the abdomen. Results Two of the patients were converted to open surgery because of incarcerated calculi or difficult exposure of the gallbladder. LC was completed in the other 33 patients successfully. The mean operation time was 65 rain （ranged from 45 to 125 rain） , and intraoperative blood loss was 20 ml in average （5 -200 ml）. The patients were followed up for 3 to 20 months with a mean of 10 months, none of them had massive hemorrhage or biliary leakage after the procedure. Conclusion TSLC is safe and feasible with good cosmetic outcomes.