门诊单孔腹腔镜胆囊切除术的应用

目的探讨门诊单孔腹腔镜胆囊切除术（OPSILC）的安全性、可行性及优势。方法自2008年12月至2010年10月,共完成41例OPSILC,患者的术前检查及手术均在门诊完成,术中在脐周做一个长2-2.5 cm的半圆形切口,将3个5 mm穿刺器分别经该切口穿刺进腹,采用5 mm可调节角度的腹腔镜以及超声刀、可弯曲的腹腔镜手术器械完成手术。结果本组42例患者,OPSILC 41例,中转行常规腹腔镜胆囊切除术1例。OPSILC平均手术时间为52.5 min,平均术中出血量为16.0 ml。术后平均进食流质时间为10.2 h,进食半流质时间为15.5 h。12例于手术当天出院,其余29例于术后第2天出院,平均术后院内观察时间为18.5 h。术后1例切口轻度感染,1例出现尿潴留。术后4周对全部患者进行电话问卷随访,结果显示患者均对OPSILC的美容效果表示满意,总体满意率为98%。结论 OPSILC是安全的、可行的,具有术前不适少、手术切口小、患者满意度高等优点。使用可调节角度的腹腔镜和弯曲的腹腔镜手术器械使OPSILC更简便易行,手术时间也随之缩短。

Application of outpatient single-incision laparoscopic cholecystectomy

Objective To study the safety,feasibility and benefits of outpatient single-incision laparoscopic holecystectomy（OPSILC）.Methods Forty-one patients underwent transumbilical OPSILC from December 2008 to October 2010.In all patients,the preoperative work-up and operation were completed in the outpatient clinic.To perform the operation,a 2 to 2.5 cm semi-circular incision was made around the umbilicus and three 5 mm trocars were inserted separately by direct puncture.A 5 mm flexible laparoscope,an ultracision scalpel and curved laparoscopic instruments were used to perform the operation.Results All patients except 1 were operated on successfully who were converted to conventional laparoscopic cholecystectomy.In the 41 successfully completed OPSILC patients,the median duration of operation was 52.5 minutes and the estimated operative blood loss was 16.0 ml.The time to resume liquid food was 10.2 hours and semi-liquid food was 15.5 hours after the operation.Twelve patients were discharged on the same day,and 29 on the second day after the operation.The mean postoperative in-hospital observation time was 18.5 hours.Slight incision infection and urinary retention was observed in 1 patient each.The follow-up was conducted for all patients at 4 weeks after operation.All patients were satisfied with the good cosmetic effect of the operation.The total satisfaction rate was 98%.Conclusions OPSILC is a safe and feasible technique for operating with less damage and little perioperative discomfort at the same time.Using a flexible laparoscope and curved instruments can make the procedure easier and more time-saving.