单孔双视免气腹腹腔镜胆囊切除术的临床应用体会

目的:探讨单孔双视免气腹腹腔镜胆囊切除术的临床疗效。方法:2013年11月至2016年5月为167例胆囊良性病变患者行单孔双视免气腹腹腔镜胆囊切除术,剑突下偏右做2.0~2.5 cm切口,用吸切剥离器解剖出胆囊管及胆囊动脉,夹闭后切断,左手指沿胆囊与肝脏间隙轻柔剥离,右手提起胆囊管轻轻旋转,双手配合完成胆囊切除术。合并胆总管结石的患者,切开胆总管,采用胆道镜取石,其中11例行胆总管一期缝合,5例放置T管。结果:167例手术均获成功,5例合并胆总管结石患者因操作部位深且粘连炎症重,适当扩大切口至3.5 cm。手术时间平均(40.0±8.9)min;术中出血量平均(20.5±4.6)ml。术后切口疼痛轻微,无出血、胆漏等并发症发生。3例术后胆囊窝积液经保守治疗后痊愈。单纯胆囊切除术后3~4 d出院;行胆总管取石的患者术后7 d出院,3个月后门诊常规行胆道镜检查,无残留结石后拔除T管。167例患者术后随访8~12个月,均恢复良好。结论:单孔双视免气腹腹腔镜胆囊切除术适应证广、安全、可行,疗效满意。

Single-port double-view gasless laparoscopic cholecystectomy

Objective:To investigate the clinical efficacy of one-port double-view pneumoperitoneum-free laparoscopic chole-cystectomy ( ODPLC) .Methods:From Nov.2013 to May 2016 ,167 patients with benign lesions of gallbladder underwent ODPLC .The length of right paramedian incision was 2 cm to 2.5 cm under xiphoid process ,cystic duct and cystic artery was dissected with suction stripper,clipped respectively and then cut off .Left fingers peeled the clearance along the gallbladder and liver gently ,while the right fin-gers lifted the cystic duct and rotated it softly ,and the completion of cholecystectomy needs the cooperation of both hands .Laparoscopic exploration of common bile duct with choledochoscopy via common bile duct incision was performed in patients with choledocholithiasis . Primary suture of common bile duct was performed in 11 cases,and T tubes were placed in 5 cases.Results:All the 167 operations gained success ,however , due to deep sites and serious adhesion in 5 patients with choledocholithiasis , the incision was extended to 3.5 cm.The average surgery time was (40.0 ±8.9 ) min.Intraoperative bleeding was (20.5 ±4.6) ml.Patients suffered from slight incision pain without complications such as bleeding or bile leakage .Three cases of gallbladder fossa hydrops recovered after conserva-tive treatment.Patients who underwent simple cholecystectomy were discharged from hospital after 3 to 4 d,while it extended to 7 d in patients with choledochotomy .The T tube was removed until no residual calculus was found by choledochoscopy three months later .Post-operatively,all the patients recovered well after a follow-up for 8 to 12 months.Conclusions:ODPLC indicates a wide-ranging indica-tion,safety,feasibility and satisfied results ,and is worthy of clinical application .