经脐入路腹腔镜手术的初步临床报告

目的探讨经脐入路内镜手术(transumbilical endoscopic surgery,TUES)的临床应用。探索操作更为简单、安全的腹壁无瘢痕手术入路。方法13例分别实施TUES肝囊肿开窗引流(1例)、腹腔探查(1例)、阑尾切除(5例)和胆囊切除术(6例)。3例用上消化道内镜及其器械完成,10例用三通道套管技术及其改良的器械完成。结果13例TUES手术均获成功。无中转常规腹腔镜或开腹手术。6例胆囊切除手术时间90~150min,5例阑尾切除手术时间15~40min,1例用普通内镜完成的肝囊肿开窗引流术手术时间90min,1例腹腔探查为膀胱周围腹膜挫伤,电凝止血,手术时间50min。无出血、胆漏等并发症发生。除脐部皱褶部位外,基本无可见的腹壁瘢痕。结论经脐入路内镜手术操作简单、安全,技术上是可行的。TUES胆囊切除难度仍较大,在开展TUES手术初期应慎重选择病例。

Preliminary Clinical Report on Transumbilical Endoscopic Surgery

Objective To discuss the clinical value of transluminal endoscopic surgery (TUES), and to find a simple and safe no-scar surgical approach. Methods A total of 13 cases of TUES, including 1 case of hepatic abscess fenestration, 1 abdominal exploration, 5 appendicectomy, and 6 cholecystectomy, were carried out in our hospital. Among the cases, 3 were accomplished using upper-digestive endoscopy, and 10 were performed using triple-channel catheter technique by modified instruments.Results All the operations were completed successfully without conversion to routine laparoscopic surgery or open surgery. The operation time was 90-150 min in the 6 cases of cholecystectomy, 15-40 min in the 5 cases of appendectomy, 90 min in the hepatic abscess fenestration, and 50 min in the abdominal exploration. The abdominal exploration showed peritoneal abrasion around the bladder, and the hemorrhage was controlled by electric coagulation. No complications including hemorrhage and biliary fistula occurred in this series. No abdominal scar was found after the operation except in the skinfolds around the hilum. Conclusions The TUES is a simple, safe, and feasible technique. Since the TUES for cholecystectomy is difficult, the patients should be selected carefully.