用改进的器械行经脐入路腹腔镜胆囊切除术

目的 近年经脐入路内镜手术(transumbilical endoscopic surgery,TUES)成为微创外科技术研究热点.其存在的主要问题是脐周围狭小区域内器械之间的相互冲突造成的操作困难.笔者尝试用改进的器械实现腹壁完全无可见瘢痕的经脐入路腹腔镜胆囊切除术.方法 54例胆囊疾病(胆囊息肉13例,结石41例)病人行TUES胆囊切除术.沿脐周呈倒三角形置入2只改进的5 mm操作套管和1只普通5 mm套管.分别置入5 mm腹腔镜和加长的操作器械完成TUES胆囊切除.结果 所有病例手术均获成功.无中转常规腹腔镜或开腹手术.手术时间25～56 min,平均(34±28)min.所选病例均未放置引流.无出血、胆漏等并发症发生.除脐部皱折部位外,基本无可见的腹壁瘢痕.结论 用改进的器械行经脐入路腹腔镜胆囊切除术,可以克服脐周器械之间的外部冲突,使该技术操作难度大为降低.

Transummhilical laparoscopic cholecystectomy with improved instruments

Objective The major barrier to transumbilical endoscopic surgery is from external interference between the instruments handles around the umbilicus. We describe the technique of totally transumbilical endoscopic cholecystectomy by using improved instruments. Methods 54 cases of transumbilical laparoscopic cholecystectomy were performed with improved instruments in patients with gallbladder polyps (13 cases) and gallstones (41 cases). The new trocars without the proximal seal system on the sleeves were designed for this procedure. The instruments used in this study were 5 cm longer than commercially available ones. Results All the gallbladders were removed successfully without severe intraoperative bleeding during and postoperative complications. Mean operating time was 25-56 min (average 34±28 min). All the patients were satisfied with the abdominal cosmetic results, discharged 48 h after the operations, and returned to work within seven postoperative days.Conclusions The external interference between trocars and instruments can be partially avoided by using the improved instruments. Totally transumbilical laparoscopic cholecystectomy becomes feasible by this technique.