三点悬吊与完全单孔腹腔镜胆囊切除43例临床分析

目的总结43例单孔腹腔镜胆囊切除的手术经验，探讨其学习曲线及实用性推广。方法回顾性分析2010年7月至2011年12月收治43例胆囊功能障碍、有症状胆囊结石或胆囊息肉患者，甄选行单孔腹腔镜胆囊切除术（试验组），与同期行传统三孔腹腔镜胆囊切除术49例（对照组）比较，统计分析两种术式的手术时间、患者术后并发症发生率及总住院时间。结果试验组三点悬吊法完成15例，完全单孔法完成26例，2例中转传统三孔腹腔镜胆囊切除。试验组平均手术时间为（72.8±9）min，第1例患者手术时间为96 min，随着手术经验积累，从第10例开始，平均手术时间缩短至（62.5±5）min，与对照组平均手术时间（59.4±3）min相比，差异无统计学意义（t=4.04，P=0.16）。试验组平均住院时间（3±1.1）d，对照组为（4±0.87）d，两组比较差异无统计学意义（t=3.28，P=0.17）。术后随访2~12个月，试验组1例患者出现切口液化，对照组2例患者出现伤口感染。两组患者均无切口疝，胆道损伤等并发症。结论单孔腹腔镜胆囊切除安全可行，其平均手术和住院时间与传统腔镜胆囊切除相近，但切口少，术后切口疼痛轻，美容效果好。经过10例手术可完成单孔胆囊切除学习曲线。

Experience of three-point retraction with total single port cholecystectomy in 43 patients

Objective To summarize the experience of performing single-port laparoscopic cholecystectomy. Methods From July 2010 to Dec 2011, the clinical data of 43 cases undergoing single port cholecystectomy were analyzed retrospectively,and compared with 49 cases （control group） on operative time, postoperative complications and hospital stay of traditional three-hole laparoscopic cholecystectomy. Results Fifteen cases in the trial group underwent three-point retraction, 26 cases underwent total single port cholecystectomy, and 2 cases were converted to traditional three-hole laparoscopic cholecystectomy. The operative time of single port for the first case was 96 min. After the first 10 cases, the average operation time was shortened to （62.5±5） min, compared with that of （59.4±3） min of the control group;the difference was not statistically significant （t=4.04, P=0.16）. Average hospital stay was （3±1.1） d in the experimental group, and （4±0.87） d in the control group;the difference was not statistically significant （t=3.28, P=0.17）. Postoperative follow-up lasted from 2 to 12 months, and 1 case in the trial group had wound liquidation, 2 patients of the control group had wound infection. No patients had no incisional hernia, bile duct injury and other complications. Conculsions Single port cholecystectomy is both safe and effective, with an appropriate operative time and hospital stay compared with the traditional three-port cholecystectomy. The learning curve needs approximately 10 cases.