单孔腹腔镜胆囊切除术的临床应用研究

目的:探讨单孔腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床应用价值及手术技巧。方法:回顾分析2013年11月至2016年5月为27例患者行经脐单孔LC的临床资料。其中胆囊结石10例,胆囊息肉15例,胆囊结石合并胆囊息肉2例。做脐下缘弧形切口,采用三通道套管,胆囊动脉及胆囊管使用5 mm钛夹夹闭。观察手术并发症、手术时间、手术效果。结果:24例成功完成手术,2例因胆囊分破、胆囊动脉出血中转为三孔法,1例因胆囊三角粘连、分离困难中转开腹。手术时间平均(57.83±7.44)min。术中出血量10 ml,均未放置腹腔引流管。术中无副损伤,术后无出血、胆漏等并发症发生。脐部切口愈合后疤痕隐蔽,患者对治疗及美容效果满意。结论:经脐单孔LC较传统LC操作困难,但腹壁美容效果较好,具有临床推广价值。

Clinical study of transumbilical single-port laparoscopic cholecystectomy

Objective:To explore the clinical value and surgical technique of transumbilical single-port laparoscopic cholecystectomy (LC).Methods:Clinical data of 27 paients who underwent transumbilical single-port LC from Nov.2013 to May 2016 were retrospectively analyzed.There were 10 cases of cholecystolithiasis,15 cases of gallbladder polyps and 2 cases of cholecystolithiasis combined with polyps.Through a 2 cm transumbilical incision,a tri-channel Trocar was placed,the cystic duct and artery was closed with 5 mm titanium clips.The operation complications,operation time and effect were recorded.Results:In 27 cases,24 cases were successful.Two cases were converted to three-port LC because of gallbladder rupture or bleeding of gallbladder artery,one case was converted to open cholecystectomy because of the gallbladder triangle adhesion and difficulty in separation.The operation time was (57.83 ± 7.44) min in average.The operative bleeding volume of these cases was less than 10 ml without abdominal cavity drainage tube.No vice-damage,postoperative bleeding or bile leakage were found.Umbilical scar was hidden and patients were satisfied about the treatment and cosmetic effect of transumbilical single-port LC.Conclusions:Transumbilical single-port LC is more difficult than traditional LC,but it is associated with excellent cosmetic effect in abdominal wall and is worthy of clinical popularization.