经脐部三孔法腹腔镜胆囊切除术

目的 探讨经脐三孔腹腔镜胆囊切除术(transumbilical laparoscopic cholecystectomy, TULC)的可行性. 方法 取脐下缘10 mm、脐右上缘3 mm及脐左上缘5 mm穿剌孔,分别置入Storz 10 mm 30°腔镜及直线型刚性器械,超声刀或电凝钩进行组织分离,应用腔镜下结扎缝...

Transumbilical Laparoscopic Cholecystectomy with Three Trocars

Objective To investigate the feasibility of transumbilical cholecystectomy with laparoscopy with three trocars.Methods Three trocars were placed at 10 mm below and 3 mm above the umbilicus,and 5 mm to the left upper edge of the umbilicus.Storz 10 mm 30° laparoscope and rigid instruments were used.Ultrasonic scalpel or electrocoagulation was employed to separate the tissues,and then the cystic duct and/or cystic artery were sutured under the laparoscope. Results Totally 160 patients received the operation;none of them were converted to conventional laparoscopy or open surgery.Partial cholecystectomy was carried out in three of the patients because of severe inflammation of the cyst.Hepatic cyst fenestration was carried out in 1 case,and cholecystocolonic fistulectomy was performed on two patients.The operation time in this series ranged from 20 to 250 minutes（the mean time for fenestration was 65 minutes）.No uncontrollable bleeding,bile leakage,or infections occurred in the patients.A follow-up for a mean of 10.6 months（1-15 months） were achieved in 141 patients,of which,two cases complained of mild right upper abdominal pain without showing residual cyst,gallbladder forssa effusion or bile duct stones by B-ultrasonography;one patient developed chronic diarrhea and was then cured by dietotherapy. Conlcusions Transumbilical laparoscopic cholecystectomy with three trocars is safe and feasible.