经脐单孔与三孔法腹腔镜胆囊切除术治疗结石性胆囊炎的对比分析

目的对比经脐单孔与三孔法腹腔镜胆囊切除术治疗结石性胆囊炎的疗效。方法 2010年9月～2011年5月,年龄18～50岁并经B超确诊入院的有症状结石性胆囊炎患者,按患者意愿分成2组(单孔组及三孔组各60例,单孔组应用国产单孔经脐腹腔镜器械),对比2组的手术时间、术后住院时间、切口疼痛评分、术后应用镇痛药、并发症、腹壁美容满意度评分。结果 2组手术均获成功。与三孔组相比,单孔组虽然手术时间长(61.5±11.4)min vs.(39.5±7.8)min,t=12.238,P=0.000],但术后切口疼痛VAS评分低(3.4±0.7)分vs.(4.5±0.5)分,t=-8.373,P=0.000],应用镇痛药例数少(11例vs.22例,χ2=5.057,P=0.025),术后2个月腹壁美容满意度评分高(4.3±0.7)分vs.(3.9±0.6)分,t=3.125,P=0.002]。2组术后住院时间和并发症率差异无显著性(P>0.05)。结论 在严格掌握手术适应证的前提下,完全经脐单孔腹腔镜胆囊切除术治疗结石性胆囊炎可达到三孔法相近的临床疗效,并且术后切口疼痛明显减轻,腹壁美容效果好。

Comparison between Transumbilical Single-port and Three-port Laparoscopic Cholecystectomy for Calculous Cholecystitis

Objective To compare the efficacy of transumbilical single-port and three-port laparoscopic cholecystectomy(LC) for the treatment of calculous cholecystitis. Methods During September 2010 to May 2011,120 patients(18 to 50 years old),who were diagnosed with symptomatic calculous cholecystitis by B-ultrasonography were divided into single-and three-port groups based on the willingness of the patients(60 in each).The operation time,postoperative hospital stay,incisional pain,analgesic consumption,complications,and satisfaction with the abdominal cosmetic outcomes were compared between the two groups.ResultsAll the operations were successfully performed.The single-port group showed significantly longer operation time but lower VAS,less analgesic consumption,and higher satisfaction with cosmetic results (61.5±11.4) min vs.(39.5±7.8) min,t=12.238,P=0.000;3.4±0.7 vs.4.5±0.5,t=-8.373,P=0.000;11 cases vs.22 cases,χ2=5.057,P=0.025;and 4.3±0.7 vs.3.9±0.6,t=3.125,P=0.002].No significant difference was detected in the postoperative stay and rate of complications between the two groups(P>0.05).Conclusions With strict surgical indications,total transumbilical LC can achieve similar clinical effects with three-port LC,significantly reduce postoperative wound pain,and leads to good cosmetic result at the abdominal wall.