隐瘢痕腹腔镜胆囊切除术:一种美容效果与经自然腔道内镜手术等效的手术径路

目的:介绍一种腹部无明显手术瘢痕的腹腔镜胆囊切除术式。方法:女性胆囊良性病变25例。在脐部穿刺10mm Trocar,作为主操作孔和取出胆囊的通道。在阴毛上缘两端各穿刺5mm Trocar,一个进出5mm腹腔镜,另一个进出抓钳。术者用5mm超声刀离断胆囊管和胆囊血管,然后用电凝钩分离胆囊床,用可吸收圈套线结扎胆囊管。切下的胆囊从脐部戳孔取出。最后用可吸收线关闭脐孔,阴毛处戳孔用胶布拉拢覆盖。结果:手术全部成功,手术时间17～35min,平均25min。均未放置引流管,术后无出血、胆漏等并发症发生。术后住院1～3d。随访1～3个月,戳孔均愈合良好,脐部和阴毛处看不出手术瘢痕。患者对手术结果满意。结论:将戳孔设在脐孔和阴毛上缘行腹腔镜胆囊切除术,能达到隐藏手术瘢痕的目的。

Scar-hidden laparoscopic cholecystectomy:an approach with cosmetic results equivalent to the natural orifice transluminal endoscopic surgery

Objective:To introduce a novel approach of laparoscopic cholecystectomy to obtain cosmetic results equivalent to the natural orifice transluminal endoscopic surgery(NOTES).Methods:Twenty-five female patients with benign gallbladder disease were enrolled in this study.An incision of 10mm was made in umbilicus for operative instruments.Two 5mm incisions were made in the upper pubic hair fringe,one for 5mm laparoscope and the other for a grasper.Ultrasound scalper was used to cut the cystic duct and vessels,followed by dissecting gallbladder bed using an electric hook.Then the cystic duct stump was ligated by an absorbable endo-loop.Finally,after the gallbladder was removed out through the umbilicus,the incision in the umbilicus was closed using absorbable thread,while the incisions in the upper fringe of pubes were just pulled together by adhesive plaster without suturing.Results:All the operations were successfully performed.Mean operative time was 25min(17-35min).No postoperative complications occurred.The postoperative hospital stay was 1-3d.All patients were very satisfactory with the cosmetic results after 1-3 months follow-up for scars were invisible.Conclusions:Laparoscopic cholecystectomy can be safely performed with no obvious scars by placing incisions in the umbilicus and the upper pubic fringe.