经脐单孔腹腔镜技术在肝胆外科疾病治疗中的应用

目的 探讨经脐单孔腹腔镜技术在肝胆外科疾病治疗中的安全性和可行性.方法 分析总结我院2010年5月至2011年5月应用单孔腹腔镜技术选择性对71例患有肝胆疾病患者的手术资料,其中胆囊结石39例,胆囊息肉15例,肝囊肿14例,肝癌1例.结果 69例患者均成功实施了单孔手术,2例胆囊结石患者,由于局部粘连较重,改常规腹腔镜手术.行胆囊切除54例,手术时间45～ 95 min;肝囊肿14例,行囊肿开窗术手术时间25～45 min;左肝外叶边缘肝癌1例,行肝楔形切除术,手术时间145 min.术后无黄疸、胆汁漏、出血和切口感染等并发症.脐部切口瘢痕小而隐蔽,无明显可视瘢痕.结论在现有条件下单孔腹腔镜手术操作难度较大,术前和术中慎重把握手术适应证,及时改变手术方法,对多数患者经脐单孔腹腔镜手术是安全的,具有极好的美容效果.     

经脐单孔腹腔镜胆囊切除术疗效观察

目的观察经脐单孔腹腔镜胆囊切除术的疗效。方法 17例胆囊疾病患者,均于脐部上方做一长1.5cm弧形切口,用自制防漏气装置建立腹腔镜操作通道,用普通腔镜器械行胆囊切除术。结果手术均获成功。术中无操作孔相关并发症。手术时间50-90 min。未放置引流管,术后无并发症。结论经脐单孔腹腔镜胆囊切除术安全有效。     

急性胆囊炎腹腔镜胆囊切除术53例临床分析

目的探讨急性胆囊炎行腹腔镜胆囊切除术（LC）的手术技巧。方法急性胆囊炎行LC 53例,中转开腹3例。回顾53例LC操作经验并进行总结分析。结果 50例LC手术成功,手术时间30～180 min,平均79 min,术中出血5～200 ml,平均住院6.5d（3～16 d）。结论急性胆囊炎首选LC。腹腔镜下顺行切除胆囊更加安全、快捷。     

单孔腹腔镜直肠前切除术的临床应用

目的探讨常规腹腔镜器械在单孔腹腔镜直肠前切除术中的可行性和安全性。 方法采用常规腹腔镜器械,完成3例经脐单孔腹腔镜直肠前切除术。 结果3例患者平均手术时间155 min,术中出血量50～100 ml。随访2年,肿瘤无复发。结果 无一例中转开腹,手术时间平均(123±85) min,平均失血量为87 ml。下切缘为2～5 cm;术后平均住院时间为8 d ;吻合口漏1例,无盆腔感染、肠梗阻、腹腔及盆腔出血、吻合口出血及吻合口狭窄等并发症。 结论采用常规腹腔镜器械经脐行单孔腹腔镜直肠前切除术安全可行。     

经脐单孔腹腔镜胆囊切除术及术中使用超声刀直接处理胆囊动脉的疗效分析

目的探讨经脐单孔腹腔镜胆囊切除术及术中超声刀直接处理胆囊动脉的临床可行性及使用价值。方法回顾性分析本科室自2011年3月-2012年12月施行腹腔镜胆囊切除术并术中超声刀直接处理胆囊动脉231例患者的临床资料。根据患者要求手术方式分为经脐单孔腔镜组125例(A组)和三孔腔镜组106例(B组),比较2种术式的手术时间、术中出血量、术后镇痛、术后进食、术后住院时间、术后并发症发生情况以及超声刀直接处理胆囊动脉的效果。计量资料组间比较采用t检验,计数资料比较采用卡方检验。结果 A组手术时间平均为(20.21±1.86)min,长于B组的(18.43±1.37)min,差异有统计学意义(P0.05);A组术中出血量平均为(23.23±6.25)ml,B组为(22.34±5.49)ml,差异无统计学意义(P0.05);A组术后5例须要镇痛,B组21例,差异有统计学意义(P0.05);A组术后进食时间为(6.56±1.23)h,B组为(6.67±1.45)h,差异无统计学意义(P0.05);A组术后住院平均时间为(2.98±0.23)d,B组为(3.02±0.18)d,差异无统计学意义(P0.05);2组患者术后均未留置引流管。2组术后均无出血、胆管损伤、胆漏及切口感染等并发症发生。超生刀直接凝断胆囊动脉止血效果可靠,术后无继发性出血发生。所有患者术后随访2~12个月,平均6.5个月,患者康复良好,无切口疝发生,脐部瘢痕不明显,美容效果较好。结论经脐单孔腹腔镜胆囊切除术具有三孔腹腔镜胆囊切除术相同临床效果,并且具有创伤小,术后疼痛轻、美容效果好等优势,特别适用外貌美容要求较高的患者。超声刀直接离断胆囊动脉能够减少由于仔细分离胆囊动脉而意外造成的大出血,同时也相应缩短手术时间,是一种安全、可行的手术方式,值得临床推广应用。     

腹腔镜胆囊切除术的演变与思考

腹腔镜胆囊切除术（LC）问世二十多年来,已成为国际上公认的胆囊切除的金标准术式。随着微创外科概念和腹腔镜-内镜技术的迅速发展,近年来腹壁无瘢痕手术引起外科界的关注。本文对于经脐单孔腹腔镜胆囊切除术的手术器械、操作技术进行探讨,希望通过改进其手术操作的方便性及安全性,提高其普及应用的可行性。     

腹腔镜下多脏器联合手术16例报告

对16例需同时处理两种以上腹腔内病变的患者行腹腔镜下多脏器联合手术，包括胆囊切除术、妇科手术及阑尾切除术。结果手术均获得成功，无中转开腹。手术时间平均85min，术中平均出血45ml，住院2～5d。提示一次腹腔镜手术同时处理两种以上腹腔内病变安全可行，可减少传统开腹联合手术引起的创伤。     

经脐单孔腹腔镜全子宫切除术患者的护理

目的总结经脐单孔腹腔镜全子宫切除术的护理经验,为该术的护理提供临床借鉴。方法选取2014-01～2017-12实施经脐单孔腹腔镜全子宫切除术患者80例,对其临床资料进行回顾性分析并总结护理经验。结果 80例患者手术均获成功,无术中、术后严重并发症发生。术后切口疼痛评分平均得分为(1.10±0.26)分,术后肛门排气平均时间为(24.00±8.24) h,平均住院时间为(6.56±0.82) d,脐部切口美容满意度为(4.81±0.38)分。出院后至3个月随访,患者对腹壁切口美容效果满意,脐部切口愈合好,无明显瘢痕,均未发生手术切口不良愈合、切口感染、切口疝等情况,大小便正常。结论在经脐单孔腹腔镜全子宫切除术围手术期采取积极、有效的护理措施,可减少手术并发症的发生及加快患者的康复速度。     

经脐单孔腹腔镜加穿刺针在精索静脉曲张治疗中的应用

目的探讨经脐单孔腹腔镜加穿刺针治疗精索静脉曲张的临床疗效。方法选择精索静脉曲张患者35例,采用经脐单孔单通道腹腔镜,手术仅在脐部切开1个1.0 cm穿刺通道,在下腹壁穿刺针(气腹针Veres内芯)的辅助下完成腹膜后精索血管的高位集索结扎。结果 35例均顺利完成手术,术后住院时间2～4 d、平均3 d。随访2～18个月,无静脉曲张复发、阴囊水肿,无睾丸萎缩等远期并发症。结论单切口单通道腹腔镜下治疗精索静脉曲张经济、简便,临床疗效显著。     

胆囊后三角入路三孔法腹腔镜胆囊切除术

目的探讨胆囊后三角入路三孔法腹腔镜胆囊切除术(LC)的可行性。方法回顾分析25例胆囊后三角入路三孔法LC的临床资料,主要包括手术时间、出血量及手术并发症。结果 25例手术均获成功,无1例转四孔法,手术时间25～60 min,平均40 min;术中出血量1～10 ml,平均3 ml。全组无胆管损伤、胆漏、出血等严重并发症。25例随访4～13个月,平均7个月,无胆管狭窄及胆系症状。结论胆囊后三角入路有助于解剖和辨认Calot三角内的组织结构,可有效的减少术中出血和胆管损伤等并发症,胆囊后三角入路三孔法腹腔镜胆囊切除术是安全、可行的。     

Single port laparoscopic cholecystectomy: a new evolving technique

Although multiple groups have reported initial success with single port laparoscopy, no consensus exists concerning the technical aspect of this surgery. In this report, we describe in detail our technique to perform single port laparoscopic cholecystectomy. Twelve cases of single port laparoscopic cholecystectomy for gallbladder stones were performed in our surgical unit. There was only one conversion during the first operation of the series to standard laparoscopy, and never to open operation. No intraoperative adverse events or major perioperative complications were reported. All the patients have been discharged within 48 hours, with uneventful postoperative course, nearly painless, without any discomfort and no visible scar. Single port laparoscopic surgery is a promising option for the treatment of gallbladder stones providing that technical and oncological surgical principles are respected.     

Learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy

AIM: To investigate the learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy (SILC). METHODS: The clinical data of 180 consecutive transumbilical suture-suspension SILCs performed by a team in our department during the period from August 2009 to March 2011 were retrospectively analyzed. Patients were divided into nine groups according to operation dates, and each group included 20 patients operated on consecutively in each time period. The surgical outcome was assessed by comparing operation time, blood loss during operation, and complications between groups in order to evaluate the improvement in technique.RESULTS: A total of 180 SILCs were successfully performed by five doctors. The average operation time was 53.58 ± 30.08 min (range: 20.00-160.00 min) and average blood loss was 12.70 ± 11.60 mL (range: 0.00-100.00 mL). None of the patients were converted to laparotomy or multi-port laparoscopic cholecystectomy. There were no major complications such as hemorrhage or biliary system injury during surgery. Eight postoperative complications occurred mainly in the first three groups (n = 6), and included ecchymosis around the umbilical incision (n = 7) which resolved without special treatment, and one case of delayed bile leakage in group 8, which was treated by ultrasound-guided puncture and drainage. There were no differences in intraoperative blood loss, postoperative complications and length of postoperative hospital stay among the groups. Bonferroni’s test showed that the operation time in group 1 was significantly longer than that in the other groups (F = 7.257, P = 0.000). The majority of patients in each group were discharged within 2 d, with an average postoperative hospital stay of 1.9 ± 1.2 d. CONCLUSION: Following scientific principles and standard procedures, a team experienced in multi-port laparoscopic cholecystectomy can master the technique of SILC after 20 cases.     

Learning curve of single port laparoscopic cholecystectomy determined using the non-linear ordinary least squares method based on a non-linear regression model

Introduction

Single port laparoscopic surgery has come to the forefront of minimally invasive surgery. For those familiar with conventional techniques, however, this type of operation demands a different type of eye/hand coordination and involves unfamiliar working instruments. Herein, the authors describe the learning curve and the clinical outcomes of single port laparoscopic cholecystectomy for 150 consecutive patients with benign gallbladder disease.

Method

All patients underwent single port laparoscopic cholecystectomy using a homemade glove port by one of five operators with different levels of experiences of laparoscopic surgery. The learning curve for each operator was fitted using the non-linear ordinary least squares method based on a non-linear regression model.

Results

Mean operating time was 77.6 ± 28.5 min. Fourteen patients (6.0%) were converted to conventional laparoscopic cholecystectomy. Complications occurred in 15 patients (10.0%), as follows: bile duct injury (n = 2), surgical site infection (n = 8), seroma (n = 2), and wound pain (n = 3). One operator achieved a learning curve plateau at 61.4 min per procedure after 8.5 cases and his time improved by 95.3 min as compared with initial operation time. Younger surgeons showed significant decreases in mean operation time and achieved stable mean operation times. In particular, younger surgeons showed significant decreases in operation times after 20 cases.

Conclusion

Experienced laparoscopic surgeons can safely perform single port laparoscopic cholecystectomy using conventional or angled laparoscopic instruments. The present study shows that an operator can overcome the single port laparoscopic cholecystectomy learning curve in about eight cases.     

Use of non‐powder surgical glove for extraction of gallbladder in laparoscopic cholecystectomy

Background: The present study was conducted to evaluate the usefulness and safety of the non‐powder surgical glove for extraction of the gallbladder in laparoscopic cholecystectomy. Methods: A total of 830 patients who underwent laparoscopic cholecystectomy using the surgical glove for extraction of the gallbladder in our hospital were analyzed. The operative times, blood loss during the operation, intra‐ and postoperative complications, length of hospital stay and the rate of morbidity were evaluated. Results: The mean operative time, mean intraoperative blood loss and mean length of hospital stay were 98.9 min, 12.1 g, and 7.93 days, respectively. The most frequent complication in this study was postoperative bleeding from the liver bed or port sites. Postoperative wound infection was found in six (0.72%) of 830 cases. Umbilical port infection was found in five of six cases. Seven cases with gallbladder cancer were incidentally detected by intra‐ or postoperative pathology. Five cases underwent reoperation by open laparotomy to resect the regional lymph nodes. Two cases have been followed up, because the depth of cancer invasion was limited to the mucosa of the gallbladder. There was no intra‐abdominal abscess formation and no port site metastasis in this study. Conclusion: The use of the surgical glove for extraction of the gallbladder is safe, cheap, simple and potentially reduces significant morbidity. Its routine use at laparoscopic cholecystectomy is strongly advocated where bile leak occurs or tumor is suspected.     

Comparing of the Results between Single Port and Three Ports in Laparoscopic Cholecystectomy

Background/Aims: The aim of this prospective trial was to observe the results of the two types of techniques. Methodology: Single port laparoscopic cholecystectomy (SPLC) (56 cases) indication was polyp disease and mild cholecystitis with gall bladder stone (no right upper quadrant tenderness in physical examination, no gall bladder wall thickening in image study). Three ports laparoscopic cholecystectomy (TPLC) (46 cases) was applied to previous laparoscopic surgery indication. There were slight differences in indication as there are still limitations in applying single port laparoscopic cholecystectomy in all patients. Results: The two groups were similar with respect to demographic characteristics. There were no significant differences in operation time, bile leakage during operation, postoperative hospital stay, pain score. Additional port(s) use in single port laparoscopic cholecystectomy were 13 cases, the reasons were difficult dissection of Calot's triangle (7 cases), incomplete ligation by Hem-o-lok clip (3 cases), cystic artery bleeding (3 cases), difficult visual due to obesity (1 case). Conclusions: Single port laparoscopic cholecystectomy is still in its initial stages. Although many controversies remain regarding stability and possibility, it is believed that development and exchange of new instruments and techniques will form an important part of future minimal invasive surgery.     

经脐胃镜下保胆取石术的临床研究

目的评估经脐胃镜下保胆取石术治疗胆囊结石的临床效果和安全性。方法2018年4月至2018年7月,采用经脐胃镜下保胆取石术治疗的15例胆囊结石病例纳入回顾性分析,汇总手术完成情况、手术时间、术中出血量、并发症等。结果15例均顺利完成手术,术中患者生命体征平稳。手术时间（108±12）min（92～129 min）,术中出血10～30 mL。术后8例右上腹轻微疼痛,7例脐部切口轻微疼痛。无发热、切口感染、脐疝、腹膜炎、腹腔积液等并发症发生。所有患者术后1 d即可流质饮食,2 d可下床活动,4～5 d可出院。出院后1周所有患者恢复正常生活,术后1个月复查脐部手术瘢痕小而隐匿,体表基本无可见切口。4例术后3个月复查彩超提示胆囊收缩功能良好,无胆囊结石复发。结论经脐胃镜下保胆取石术治疗胆囊结石安全、有效,术后瘢痕小而隐匿,美容效果较好。     

Tips for single‐port laparoscopic cholecystectomy

Single‐port laparoscopic cholecystectomy (SPLC) is an emerging technique and gaining increased attention by its superiority in cosmesis. A 1.5‐cm vertical transumbilical incision is used for the single port, followed by the glove method. Indications for SPLC are the same as those for standard 4‐port laparoscopic cholecystectomy, including patients with morbid obesity, previous upper abdominal surgery, severe acute cholecystitis, or suspected presence of common bile duct stones. Some randomized controlled trials have shown negative results of SPLC regarding operative time, wound‐related complications, and postoperative pain. However, our retrospective analysis shows equivalent clinical outcomes among the two approaches in terms of postoperative pain and complications. In this context, SPLC can be a good option for gallbladder pathologies.