改良的二孔法腹腔镜胆囊切除术

目的探讨改良的二孔法腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的疗效。方法 2009年7月～2011年3月对152例胆囊良性病变脐部5 mm戳孔改用软质无通气阀的trocar,配以长柄向外侧弯曲抓钳施行二孔法LC,均未放置腹腔引流管。结果 151例成功施行二孔法LC,1例因胆囊三角显露困难行三孔法LC。手术时间35～70 min,平均45 min;术中出血量10～50 ml,平均15 ml。术后切口疼痛轻微,无出血、胆漏、感染等并发症,2例术后出现右下腹持续性疼痛,B超检查示肠道积气,经对症处理后缓解。脐部切口隐藏于脐内缘,仅剑突下一5 mm瘢痕。152例术后随访12个月,恢复良好,美容效果满意。结论改良的二孔法LC安全可行,疗效满意。

Modified Two-port Laparoscopic Cholecystectomy

Objective To investigate the clinical efficacy of modified laparoscopic cholecystectomy(LC) with two ports.Methods From July 2009 to March 2011,via a 5-mm umbilical incision,we used flexible trocar and long-handle bending tongs in LC for 152 patients with benign gallbladder lesions.No abdominal drainage was carried out after the operation.Results Two-port LC was successfully completed in 151 of the patients,and the other one was converted to open surgery because of insufficient exposure of the Calot’s triangle.The operation time ranged from 35-70 min with a mean of 45 min,and intraoperative blood loss ranged from 10-50 ml with a mean of 15 ml.After the operation,the patients complained of mild incisional pain.No hemorrhage,bile leakage,or biliary infection occurred.Two patients developed continuous right lower abdominal pain,and B-ultrasonography showed intestinal gas and then were cured by conservative treatments.The cosmetic results of the surgery were satisfying as the umbilical incision was invisible and only a 5-mm scar was visible under the processus xiphoideus.The patients recovered in a 12-month follow-up.Conclusion Modified two-port LC is safe and effective.