经脐单孔与三孔法腹腔镜胆囊切除术的对比研究

目的 探讨用普通腹腔镜器械完成经脐单孔腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的安全性、可行性及优势.方法 2011年6月至2012年11月间100例胆囊良性疾病按手术日分为两组,由同一手术组医师分别施行经脐单孔LC与三孔LC,比较两组手术时间、术中出血量、术后疼痛评分、肠功能恢复时间、术后住院时间及腹壁美容满意度评分.结果 两组手术均获成功.单孔组与三孔组相比,虽然手术时间比较长（69.1±17.2）min 与（49.8±13.6） min,P＜0.05],但术后切口疼痛视觉模拟评分法（VAS）评分低（1.2±1.0与2.5±1.2,P＜0.05）,腹壁美容满意度评分高（4.3±0.7）分与（3.6±0.6）分,P＜0.05];而术后肠功能恢复时间（20.8±10.5） h 与（21.3±10.6） h,P＞0.05 ]、术中出血量（20.5±13.2） ml与（18.9±14.2） ml,P＞0.05]、术后住院天数（2.7±1.2） d 与（2.8±1.0）d,P＞0.05]两组间差异均无统计学意义.结论 经脐单孔LC可取得与三孔LC相同的临床结果,此术式安全可行,并且术后切口疼痛明显减轻,腹壁美容效果好.

Comparative study of single versus three-port laparoscopic chelecystectomy

Objective To evaluate the safety, feasibility and advantages of transumbilical single port laparoscopic cholecystectomy （LC） with ordinary laparoscopic instruments. Methods From June 2011 to November 2012, 100 patients with gallbladder disease were assigned to undergo transumbilical single-port LC （n = 50） or three-port LC （n = 50） based on surgical dates. The operative duration, in- traoperative blood loss volume, incisional pain, intestinal function recovery time, postoperative hospi- tal stay and satisfaction with abdominal cosmetic outcomes were compared between two groups. Re- sults All operations were successfully performed. The single-port group showed significantly longer operative duration （69. 1 ± 17. 2） vs（49. 8 ± 13. 6）min, P〈0. 05], lower VAS（1.2 ± 1.0 vs 2. 5 ± 1.2,P〈0. 05）and better cosmetic outcomes （4. 3 ± 0. 7） vs （3. 6 ± 0. 6）, P〈0. 05]. No inter-group difference existed in intraoperative blood loss volume, intestinal function recovery time or length of hospital stay（P〉0. 05）. Conclusions As compared with conventional three-port LC, transumbilical single-port LC is both safe and feasible. And, with similar clinical outcomes, it significantly reduces postoperative wound pain and yields better cosmetic results of abdominal wall. Key words] Cholecystectomy; Laparoscopes; Comparative study