单孔腹腔镜手术在胆囊结石伴急性胆囊炎治疗中的应用体会

目的 探讨经脐单孔腹腔镜手术治疗胆囊结石伴急性胆囊炎的临床应用价值。方法 选取2018年3月至2020年8月期间上海市普陀区中心医院普外科同一治疗组收治的急性胆囊炎患者，按手术方式分为经脐单孔腹腔镜胆囊切除术组（SILC组，n=41）和传统三孔腹腔镜胆囊切除术组（CLC组，n=53），比较两组术中、术后情况。结果 SILC和CLC两组的术中出血量、住院时间、增加额外Trocar孔/中转开腹的几率以及术后各级并发症发生率，差异均无统计学意义（P>0.05）。针对急性胆囊炎Ⅰ级和Ⅱ级的患者，SILC组切口满意度均优于CLC组，但手术时间均比CLC组更长，差异均有统计学意义（P<0.05）。结论 做到合理运用，规范仔细操作，经脐单孔腔镜胆囊切除术与传统三孔腹腔镜胆囊切除术均能获得良好的手术效果。经脐单孔腹腔镜手术虽然手术时间较长但美容效果更好，其安全性不亚于传统三孔腹腔镜手术。     

单孔与传统腹腔镜胆囊切除术的比较：随机对照试验的Meta 分析

目的：评价单孔腹腔镜胆囊切除术（SILC）与传统腹腔镜胆囊切除术（CLC）的安全性和有效性。方法：计算机检索各数据库中有关SILC与CLC的前瞻性随机对照试验。检索时限均为建库至2012年11月。按Cochrane系统评价员手册对纳入文献的方法学质量进行评价后,提取数据,采用RevMan 5.1统计软件行Meta分析。结果：筛选后最终纳入17个研究,共1 267例患者,其中SILC组654例,CLC组613例。Meta分析结果显示,手术时间SILC组长于CLC组（WMD=13.02,95%CI=7.95~18.09,P<0.001）;术后切口外观评分和患者满意度评分SILC组优于CLC组（WMD=1.21,95%CI=0.70~1.72,P<0.001;WMD=0.76,95%CI=0.53~1.00,P<0.001）;术后并发症、术后疼痛评分和住院时间两组间差异无统计学意义（RR=1.13,95%CI=0.87~1.48,P=0.35;WMD=0.03,95%CI= -0.82~0.88,P=0.95;WMD=-0.06,95%CI=-0.40~0.28,P=0.73）。结论：对于治疗非复杂性的胆囊良性疾病,SILC是一项安全而有效的手术操作;它具有良好的切口外观和患者满意的优点。     

单孔腹腔镜与传统腹腔镜胆囊切除术治疗效果比较

目的 探讨单孔腹腔镜(SILC)与传统腹腔镜两种术式的安全性和可行性.方法 选取胆囊疾病患者54例随机分为SILC组(n=26)和三通道腹腔镜胆囊切除术(3PLC)组(n=28).收集患者年龄、体质量、身高、体质量指数(BMI)、手术时间、疼痛分数、中途转换手术率、切口满意度评分等临床资料,并进行了12个月的随访.结果 两组患者在性别、年龄、体质量、身高和BMI方面比较差异无统计学意义(P＞0.05).SILC组手术时间长于3PLC组[(56.9 ±15.8) min比(35.2±8.7) min,P＜0.01].应用相同的麻醉药品后SILC组在术后第1天较3PLC组疼痛分数更高,总的疼痛分数两者相似,差异无统计学意义(P＞0.05).SILC组患者术后伤口并发症发生率更高,但术后疝发生率相同.SILC组切口满意度评分分数更高[(11.7±0.8)分比(10.1±1.2)分,P＜0.05].结论 SILC较3PLC治疗单纯胆道疾病安全、有效.     

经脐单孔腹腔镜胆囊切除术57例临床分析

目的比较经脐单孔腹腔镜胆囊切除术(SILC)与传统腹腔镜胆囊切除术(LC)治疗老年胆囊良性疾病的效果。方法随机将2017-06—2018-03间在叶县中医院接受胆囊切除术的114例老年胆囊良性疾病患者分为2组,各57例。A组患者行LC,B组患者行SILC。结果 (1) B组术中出血量、术后排气时间和住院时间均低于A组,但手术时间长于A组,差异有统计学意义(P 0. 05)。(2) B组术后第1天和第3天时的VAS评分均低于A组,差异有统计学意义(P 0. 05)。(3) 2组术后并发症发生率差异无统计学意义(P 0. 05)。结论 SILC治疗老年胆囊良性疾病,创伤较小、术后疼痛轻、效果较好,更符合患者对美容的需求。     

单切口腹腔镜胆囊切除术与腹腔镜胆囊切除术的病例对照研究

目的回顾性分析单切口腹腔镜胆囊切除术（SILC）与传统腹腔镜胆囊切除术（LC）的优劣性。方法19例SILC及46例LC患者的临床资料,比较两者的手术时间、术中出血量、术后并发症、中转率、术后疼痛、住院时间、切口长度的差异。结果SILC手术耗时（49．00±8．34）min长于LC（P=0．000）。术中出血量差异无统计学意义。两组均无中转、术后无并发症;SILC与Lc术后患者第一天疼痛评分、术后第三天疼痛评分、总疼痛天数差异均无统计学意义。两者住院时间差异无统计学意义。SILC切口长度（22．5±3．5）mm短于LC切口长度（P=0．000）。结论SILC总切口长度短于LC总切口长度,切口效果更美观。SILC能安全地用于单纯胆囊结石、胆囊息肉。同时对于没有严重合并症和腹部手术史的胆囊疾病患者SILC也是一种理想的手术选择。     

经脐单孔腹腔镜与腹腔镜手术治疗胆囊良性疾病的疗效比较

目的 回顾性对比分析经脐单孔腹腔镜与腹腔镜手术治疗胆囊良性疾病的临床疗效.方法 回顾性分析2018年1月-2020年1月在合肥市第二人民医院普外科治疗的胆囊良性疾病的患者110例,其中选择经脐单孔腹腔镜胆囊切除术(SILC)的患者共65例,常规腹腔镜胆囊切除术(CLC)的患者45例,随访至术后1月时间,比较两组的患者相...     

经脐单孔腹腔镜与传统腹腔镜胆囊切除术的比较研究

目的评价经脐单孔腹腔镜胆囊切除术的安全性、可行性及优势。方法回顾性分析经脐单孔腹腔镜胆囊切除术组（A组,16例）及传统四孔法腹腔镜胆囊切除术组（B组,20例）临床资料,A组采用脐孔上缘20 mm圆弧形切口,切口中间穿刺置入直径10 mm穿刺鞘,观察镜进入;两侧分别置入两个5 mm的穿刺鞘,放置操作器械,器械摆放呈＂三角＂状,各穿刺鞘之间由腹壁组织相间隔。经右锁骨中线肋缘下穿刺置入直径1 mm的克氏针,以克氏针钝头辅助牵引暴露术野,完成手术操作。结果 A组与B组比较,手术时间分别为（63.1±11.2）min vs.（52.9±13.1）min,术后疼痛评分为（1.2±1.0）vs.（2.5±1.2）,均有统计学差异（P〈0.05）,而术后肠功能恢复时间、术中出血量、住院天数均无统计学差异（P〉0.05）。结论现阶段的经脐单孔腹腔镜胆囊切除术是安全可行的,且更具有微创、美容的优势。     

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。     

单中心317例日间单孔腹腔镜胆囊切除术临床疗效分析

目的 总结单中心同一术者317例日间单孔腹腔镜胆囊切除术（single-incision laparoscopic cholecystectomy,SILC）的经验与体会。方法 回顾性分析上海交通大学医学院附属仁济医院同一术者于2017年4月至2020年9月间连续完成的日间病房317例SILC的临床资料,统计中转开腹率、术中出血量、术后疼痛评分、手术时间、住院时间、住院费用、手术并发症等指标,与同期同一术者完成的323例传统四孔法LC患者数据进行比较。结果 SILC组317例患者中313例成功施行SILC,传统四孔法LC组组323例患者中316例成功施行LC,两组中转开腹率无统计学差异[4例（1.3%） vs 7例（2.2%）,χ²=0.82,P=0.362]。SILC组的术后疼痛评分、住院时间方面明显低于传统四孔法LC组（P<0.001）;但传统四孔法LC组的平均手术时间短于SILC组,住院费用明显低于SILC组（P<0.001）。两组在术中出血量、术后并发症发生率方面无统计学差异（P>0.05）。尽管总体上SILC组平均手术时间长于传统四孔法LC,但同一术者完成110例SILC手术后,SILC的平均手术时间与传统四孔法LC比较差异无统计学意义（P>0.05）。结论 SILC是安全可行的,相比于传统四孔法LC具有改善患者术后疼痛与满足美观切口需求的优势。完成学习曲线后的持续实践能够有效缩短SILC的手术时间,推荐在严格把握适应证的情况下积极开展SILC。     

单孔腹腔镜胆囊切除术的学习曲线

目的:总结单孔腹腔镜胆囊切除术(single-incision laparoscopic cholecystectomy,SILC)的经验与体会,初步研究SILC的学习曲线。方法:回顾分析2011年7月至2014年4月40例SILC患者的临床资料,按施行手术的先后顺序分成A、B、C、D四组,每组10例,分析手术时间、出血量、术后并发症等指标。结果:本组40例患者均成功施行SILC,无中转常规腹腔镜手术或开腹手术。均未放置腹腔引流管。手术时间平均(61.0±19.7)min,A组手术时间平均(79.5±21.4)min,B组平均(68.0±15.7)min,C组平均(49.3±10.0)min,D组平均(47.3±9.2)min,其中B、C组差异有统计学意义(P<0.05),A、B组,C、D组差异均无统计学意义(P>0.05)。手术出血量平均(15.3±21.1)ml。B组术后腹腔内出血1例,经保守治疗而愈,A组、B组、D组各有1例切口感染,B组、C组各有1例术中胆囊破裂,术后无黄疸、胆漏、胆管损伤、脐部切口疝等并发症发生,瘢痕不明显,美容效果满意。术后第1天进低脂半流质饮食,术后1~3 d出院。结论:SILC是相对安全的,随着手术例数的增加,手术时间明显缩短,学习曲线约为20例。     

Comparison between single-incision and conventional laparoscopic cholecystectomy: a prospective trial of the Club Coelio

Background

The aim of this study was to compare the outcomes of single-incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC).

Method

Patients’ inclusion criteria were uncomplicated gallstones, BMI ≤30, ASA score ≤2, and no past surgery in the upper abdomen. Five surgeons performed only SILC and seven only CLC. Data analyzed included operative time, morbidity, quality of life (QOL), cosmetic result, and global patient satisfaction. The last three parameters were evaluated 3 months after surgery. QOL was assessed with the Gastrointestinal Quality of Life Index (GIQLI) questionnaire. Cosmetic result and patient satisfaction were rated using a 5-grade Likert scale.

Results

This study included 104 patients operated on between April and June 2010. A SILC was performed in 35 patients and a CLC in 69. The preoperative characteristics of the two groups were similar. Median operative time for SILC was higher than that for CLC: 55 versus 40 min (p < 0.001). Postoperative complications (0 vs. 2) and postoperative GIQLI scores (123 ± 13 vs. 121 ± 18) were not significantly different between groups. Cosmetic result and patient satisfaction were better for SILC than for CLC. The percentages of results rated as excellent were 68 versus 37 % (p < 0.006) and 80 versus 57 % (p < 0.039), respectively. For the whole group, multivariate statistical analysis revealed that postoperative GIQLI score and cosmetic result were independent predictive factors of patient satisfaction. The percentages of satisfaction rated as excellent were greater in patients who had a postoperative GIQLI score ≥130 (92 vs. 49 %, odds ratio [OR] = 4, p < 0.001) and in patients who had an excellent cosmetic result (82 vs. 47 %, OR = 7, p < 0.001).

Conclusions

Compared to CLC, SILC is associated with a longer operative time, an equivalent morbidity and QOL, and a better cosmetic result. The improved aesthetic result also leads to a better global patient satisfaction.     

单切口腹腔镜胆囊切除术的安全性及可行性分析

目的 探讨单切口腹腔镜胆囊切除术的安全性、可行性.方法 随机将110例有症状的胆囊良性疾病患者分为单切口组（56例）和传统组（54例）,对比两组患者的手术时间、术中出血量、术后住院时间、术后疼痛、切口外观满意度及并发症发生情况.结果 两组患者均无中转开腹手术,两组患者在术中出血量、住院时间、术后并发症、术后痛觉评分方面差异无统计学意义（P＞0.05）.单切口组手术时间长于传统组,单切口切口外观满意度评分高于传统组,两组差异有统计学意义（P＜0.05）.结论 单切口腹腔镜胆囊切除术是安全、可行的,其优势在于提高患者切口满意度.     

A prospective,randomized, controlled,trial comparing occult-scar incision laparoscopic cholecystectomy and classic three-port laparoscopic cholecystectomy

Background

This study was designed to evaluate the outcome of laparoscopic cholecystectomy by comparing a new technique using occult-scar incision for laparoscopic cholecystectomy (OSLC) with classic three-port laparoscopic cholecystectomy (CLC). In the occult-scar incision, we moved the subcostal and subxiphoid trocar insertion sites to the suprapubic area so that operative scars were hidden in the pubic hairs and below umbilicus.

Methods

Between July 2009 and 2012, patients undergoing laparoscopic cholecystectomy were randomized to the OSLC or CLC approach after obtaining informed consent. Outcome was measured by operative time, operative complications, hospital length of stay, cost, analgesia required after surgery, and cosmetic outcomes. The patient satisfaction score (PSS) and visual analog score (VAS) also were used to evaluated the level of cosmetic result and postoperative pain.

Results

A total of 75 patients were randomized into CLC (n = 35) and OSLC (n = 40) groups. No patient was converted to an open procedure in either the CLC or OSLC group. No operative complications were reported within 30 days in either group. The PSS of 7 and 30 days after surgery were both significantly higher in the OSLC group than in the CLC group (5.8 ± 1.5 vs. 8.0 ± 1.1, P = 0.03; 6.5 ± 1.2 vs. 9.2 ± 0.8, P = 0.02). The VAS for pain was significantly lower in the OSLC group on postoperative day 3 compared with the CLC group (2.6 ± 1.2 vs. 6.3 ± 0.9, P = 0.01). There was no significant difference in operative time, hospital stay, and cost between the two groups.

Conclusions

The OSLC is a safe and feasible alternative compared with CLC in experienced hands, and it is superior for outcomes regarding pain control and cosmesis.     

多孔与经脐单孔小儿腹腔镜胆囊切除术的对照研究

目的:探讨常规多孔与经脐单孔腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗小儿胆囊结石的安全性及手术经验。方法:回顾分析15例常规多孔LC及6例经脐单孔腹腔镜胆囊切除术(single incision laparoscopic cholecystec-tomy,SILC)治疗小儿胆囊结石的临床资料、术中及术后恢复情况。结果:手术均获成功,无一例中转开腹。LC组手术时间平均(30.3±5.2)min,术后平均住院(2.0±1.1)d,SILC组手术时间平均(42.3±10.6)min,术后平均住院(2.0±1.3)d,患者术后恢复良好,无并发症发生。结论:小儿胆囊结石行SILC同样安全、有效,美容效果更好,疼痛更轻,可作为治疗小儿胆囊结石可选择的技术。     

Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data

Background

This study presents preliminary data from a prospective randomized multicenter, single-blinded trial of single-incision laparoscopic cholecystectomy (SILC) versus standard laparoscopic cholecystectomy (4PLC).

Methods

Patients with symptomatic gallstones, polyps, or biliary dyskinesia (ejection fraction <30%) were randomized to SILC or 4PLC. Data included operative time, estimated blood loss, length of skin and fascial incisions, complications, pain, satisfaction and cosmetic scoring, and conversion.

Results

Operating room time was longer with SILC (n = 50) versus 4PLC (n = 33). No differences were seen in blood loss, complications, or pain scores. Body image scores and cosmetic scores at 1, 2, 4, and 12 weeks were significantly higher for SILC. Satisfaction scores, however, were similar.

Conclusions

Preliminary results from this prospective trial showed SILC to be safe compared with 4PLC although operative times were longer. Cosmetic scores were higher for SILS compared with 4PLC. Satisfaction scores were similar although both groups reported a significantly higher preference towards SILC.     

单孔与多孔腹腔镜胆囊切除术的安全性Meta分析

目的系统评价经脐单孔腹腔镜胆囊切除术(SILC)与传统多孔腹腔镜胆囊切除术(CMLC)的有效性和安全性。 方法计算机检索CBM、CNKI、PubMed、EMbase、The Cochrane Library数据库,筛选截至2015年7月关于比较SILC与CMLC的随机对照试验(RCT),采用RevMan 5.3软件进行Meta分析。 结果本研究共纳入34篇RCT文献,合计2 951例患者(SICL组1 502例,CMLC组1 449例)。SILC组的手术时间长于CMLC组,差异有统计学意义[MD＝11.56,95%CI(8.97,14.16),Z＝8.75,P<0.000 01]。相比CMLC组,SILC组的手术转换率更高,差异有统计学意义[RR＝4.01,95%CI(2.56,6.29),Z＝6.06,P<0.000 01]。SILC组患者切口美容评分高于CMLC组,差异有统计学意义[SMD＝1.34,95%CI(0.74,1.94),Z＝4.39,P<0.000 1]。两组术中出血量、术后并发症、术后24 h疼痛评分、住院时间及恢复工作时间比较,差异无统计学意义(P>0.05)。 结论SILC是一项安全有效的手术操作方式,具有更好的美容效果,但手术时间长、术中转换率高,对术者经验和手术技巧要求更高,需综合考虑选择。     

2mm无鞘针形器械在隐瘢痕腹腔镜胆囊切除术中的应用:一种无瘢痕手术新思路

目的:探讨隐瘢痕腹腔镜胆囊切除术的手术方法及应用价值。方法:选择2011年1月至2011年6月60例无严重胆囊炎症的胆囊息肉或胆囊结石患者,随机分为2组,新方法组行隐瘢痕腹腔镜胆囊切除术,单孔组行常规单孔腹腔镜胆囊切除术,对比分析两组患者手术时间、术后切口疼痛程度、术后切口满意程度及中转率。结果:新方法组均顺利完成手术;单孔组28例顺利完成手术,2例中转常规腹腔镜胆囊切除术。新方法组与单孔组手术时间平均(14.17±3.51)min和(24.67±4.12)min,新方法组明显优于单孔组(P<0.01);术后切口疼痛程度轻于单孔组,但差异无统计学意义(P>0.05);术后患者对切口满意程度优于单孔组,差异有统计学意义(P<0.01)。两组均无出血、胆漏、胆管损伤等并发症发生。结论:隐瘢痕腹腔镜胆囊切除术安全、可行,术后瘢痕不明显且隐蔽,相对单孔腹腔镜胆囊切除术,手术时间缩短,手术难度及中转率降低,术后患者切口满意度高,为腹腔镜手术的更微创化发展提供了新的可行途径及思路。     

Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy

Background

This study aimed to compare the outcomes of single-incision laparoscopic cholecystectomy (SILC) versus conventional 4-port laparoscopic cholecystectomy (LC).

Methods

From November 2009 to August 2010, 51 patients with symptomatic gallstone or gallbladder polyps were randomized to SILC (n = 24) or 4-port LC (n = 27).

Results

Mean surgical time (43.5 vs 46.5 min), median blood loss (1 vs 1 mL) and mean hospital stay (1.5 vs 1.8 d) were similar for both the SILC and 4-port LC group. There were no open conversions and no major complications. The mean total wound length of the SILC group was significantly shorter (1.76 vs 2.25 cm). The median visual analogue pain score at 6 hours after surgery was similar (4.5 vs 4.0) but the SILC group had a significantly worse pain score on day 7 (1 vs 0). There was no difference in time to resume usual activity (mean, 5.6 vs 5.0 d). The median cosmetic score of SILC was significantly higher than at 3 months after surgery (7 vs 6).

Conclusions

SILC was feasible and safe for properly selected patients in experienced hands.