经脐单一部位腹腔镜急腹症探查术100例报告

目的探讨经脐单一部位腹腔镜技术在急腹症诊疗中的安全性和可行性。方法回顾性分析2011年1～9月100例以急腹症行经脐单一部位腹腔镜探查的临床资料。经脐纵行切口20mm，置人硅胶切口保护套（欣皮护）后送入腹腔镜trocar并开始注气，5mm治疗镜探查腹腔；根据不同病变，采用相应的治疗措施。结果100例中，85例为急性阑尾炎，其中76例经脐提出阑尾切除，因阑尾坏疽，局部炎症重，或腹膜后位阑尾，4例行经脐单一部位腹腔内阑尾切除；5例从耻骨上另外置入5mmtrocar完成腹腔内阑尾切除。8例胃穿孔，其中6例经脐单一部位行修补术，2例从右上腹置入5mmtrocar完成修补术。1例出血性小肠炎，经脐提出行回肠切除、空肠造瘘术。2例女性盆腔感染，经脐单一部位行盆腹腔灌洗术。1例卵巢囊肿蒂扭转，经脐单一部位行卵巢囊肿切除术。1例下腹局部肠粘连，经脐单一部位行粘连松解术。2例术中发现腹腔内有乳糜样积液，其中1例为自发性乳糜性腹膜炎，经钛夹夹闭渗漏淋巴管和腹腔冲洗后治愈，另1例为空肠系膜淋巴管瘤，中转开腹切除。术后脐部渗液3例，肠麻痹2例。术后随访6～9个月，脐部切口愈合好，隐蔽，无脐切口疝。结论应用小的硅胶切口保护套经脐单一部位腹腔镜探查安全可行，美容效果较好。

Transumbilical Laparoendoscopic Single-site Surgery for Acute Abdomen:Report of 100 Cases

Objective To investigate the feasibility and safety of transumbilical laparoendoscopic single-site surgery （LESS） for acute abdomen. Methods We reviewed 100 cases of acute abdomen who were admitted to our hospital between January and September2011. With a silicon incisional protector, LESS for exploration and further procedures were carried out via a 20-mm transumbilical vertical incision. All the procedures were completed with a 5-mm laparoscope through the transumbilical port. Results Of the 100 patients, 85 cases were acute appendicitis, of which, 76 cases underwent transumbilical single-site laparoscopic-assisted extracorporeal appendectomy, 4 cases underwent single-site intraabdominal appendectomy,and the other 5 needed a 5-mm suprapubic port to remove the appendix. In the other 15 patients, gastric perforation was detected in 8, 6 of them received transumbilical single- site laparoendoscopic repair, and the other 2 needed a 5-mm suprapubic port to complete the procedure; hemorrhagic enteritis was found in one patient, who received transumbilical resection of the effected ileum, and then jejunostomy; pelvic infection was detected in two female patients, who then underwent abdominal and pelvic irrigation; torsion of ovarian cyst and lower abdominal intestinal adhesion were found in 2 patients, respectively, who then received resection of the ovarian cyst or lysis by transumbilical LESS; intraabdominal chyle effusion was explored intraoperatively in the other 2 patients, one of them was confirmed with spontaneous chyle peritonitis, and was cured by closing the leaking lymphatic with titanium clips and intraabdominal irrigation, and the other one was diagnosed with lymphangioma of the jejunum mesentery, and thus was converted to an open surgery for resection of the tumor. After the operations, 3 patients developed umbilical secretion, and two showed enteroparalysis. All the patients were followed up for 6 to 9 months, during which the umibical incision was healed well in all the cases without any incisional hernia occurred. Conclusion Transumbilical LESS with a silicon incisional protector is feasible and safe for acute abdomen with good cosmetic results.