经腹白线腹腔镜胆囊切除术:一种新的隐瘢痕胆囊切除术式

目的:通过与经脐腹腔镜胆囊切除术相比,验证经腹白线腹腔镜胆囊切除术在避免术中器械干扰、减轻术后疼痛和美容效果等方面的优越性。方法:随机将患者分为2组:经腹白线腹腔镜胆囊切除(translinea alba laparoscopic cholecystectomy,TLLC)组20例,经脐入路腹腔镜胆囊切除(transumbilical laparoscopic cholecystectomy,TULC)组18例。两组均采取3孔法。前者2个5mm戳孔在脐部,1个5mm戳孔位于耻骨正上方1～2cm处。后者3个5mm戳孔均在脐部。比较两组的手术时间、手术并发症、术后VAS疼痛评分、术后住院时间、美容效果满意度等。结果:38例手术均获成功,无并发症发生。TLLC组手术时间10～21min,平均(16.3±2.8)min,明显短于TULC组的32～52min[平均(43.4±2.8)min],差异有统计学意义(P0.001);TLLC组术后第1天VAS评分[(2.4±0.7)分]显著低于TULC组[(4.5±0.9)分](P0.001);两组术后切口满意度及术后住院时间差异无统计学意义(P0.05)。结论:TLLC是美容效果与TULC相当的新型隐瘢痕术式,与TULC相比,具有手术难度小和术后疼痛轻等优点。

Translinea alba laparoscopic cholecystectomy:a novel scar-hidden procedure for cholecystectomy

Objective:To verify that the novel procedure developed for laparoscopic cholecystectomy has the advantages of better cosmetic results,less instrumental clashing during operation and reduced postoperative pain over the already used procedure called transumbilical laparoscopic cholecystectomy (TULC).Methods:Thirty-eight patients with benign gallbladder disease were randomly divided into two groups according to the approach taken for them:translinea-alba laparoscopic cholecystectomy (TLLC) for 20 patients and TULC for 18 patients.Three-port technique was used in the 2 groups.In TLLC group,two 5mm incisions were made in the umbilicus and a 5mm incision was made in the suprapubic region covered with hair,while in TULC group,three 5mm incisions were all made in the umbilicus.Operating time,operative complications,postoperative hospital stay,postoperative pain and cosmetic results between the two groups were compared.Results:All operations were successfully performed without complications.The operative time were 10-21min[mean (16.3±2.8)min] for TLLC group and 32-52min [mean (43.4±2.8)min] for TULC group (P<0.001).The postoperative pain (VAS) at day one[(2.4±0.7) vs.(4.5±0.9)] were significantly less in the group of TLLC than that in the group of TULC (P<0.001).There was no significant difference between the two groups in postoperative hospital stay and cosmetic satisfaction(P>0.05).Conclusions:TLLC is a new kind scar-hidden laparoscopic cholecystectomy with equivalent cosmetic effect to TULC.Compared with the TULC,TLLC has the advantages of lower difficulty in manipulation and reduced postoperative pain.