剑突下微切口二孔法腹腔镜胆囊切除术的临床应用体会

目的 探讨剑突下3 mm鞘管（微切口）二孔法腹腔镜胆囊切除术的应用体会。方法 回顾性分析2018年6月至2019年5月在宁夏医科大学附属吴忠市人民医院和宁夏回族自治区人民医院实施剑突下微切口（4 mm），配合右侧腋前线肋缘下针式组合式显露器进行二孔法腹腔镜胆囊切除术的36例患者临床资料。结果 36例中除1例改为三孔法外，其余35例均顺利完成手术，成功率97.2%。手术时间（38.2±10.5）min，术后平均住院时间2.3 d，所有患者术后均无出血、胆漏、胆道损伤等并发症的发生。总体住院费用低于三孔法腹腔镜胆囊切除术。结论 剑突下微切口二孔法腹腔镜胆囊切除术，术中显露满意，操作方便易学，术后外观几乎等同于单孔腹腔镜效果，此术式符合微创美观、操作简便、经济实用、安全可靠的原则，值得进一步推广。

Clinical application of two-port laparoscopic cholecystectomy with sub-xiphoid mini-incision

Objective To investigate the feasibility of two-port laparoscopic cholecystectomy through 3 mm sheath (micro incision) under xiphoid process. Methods The clinical data of 36 cases who underwent two-port laparoscopic cholecystectomy with sub-xiphoid mini-incision (4 mm), combined with right anterior axillary costal edge and exposure device, in Wuzhong People’s Hospital Affiliated to Ningxia Medical University and People’s Hospital of Ningxia Hui Autonomous Region from Jun. 2018 to May 2019 were retrospectively analyzed. Results Among the 36 cases, 35 cases successfully completed the operation, except for one who converted to three-hole laparoscopic cholecystectomy, with a success rate of 97.2%. The operation time was (38.2±10.5)min, and the average hospitalization time were 2.3 days. No complication occurred such as bleeding, bile leakage or bile duct injury. The total cost of hospitalization was lower than that of three-hole laparoscopic cholecystectomy. Conclusion Two-port laparoscopic cholecystectomy with sub-xiphoid mini- incision is easy to learn and operate. The postoperative appearance is almost equivalent to the effect of single hole laparoscopic cholecystectomy. This operation is in line with the principle of minimally invasive and beautiful, simple operation, economical and practical, safe and reliable, which is worthy of further research and promotion.