急性胆囊炎单孔腹腔镜胆囊切除术与传统腹腔镜手术的对比研究

目的:探讨"三点法"经脐单孔腹腔镜胆囊切除术(single-incision laparoscopic cholecystectomy,SILC)治疗急性胆囊炎的可行性。方法:回顾分析2016年3月至2017年3月因急性胆囊炎行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)(LC组,n=46)与SILC(SILC组,n=38)患者的临床资料,比较两组手术时间、术中出血量、术中置管率及留置时间、术后6 h疼痛指数、术后体温变化、术后切口感染及脂肪液化率、肠蠕动恢复时间、术后住院时间、手术相关并发症等指标。结果:SILC组中32例成功完成手术,LC组中44例成功完成手术,术后两组均发生1例胆漏。两组术后留置腹腔引流管率及置管时间、术后体温大于37.5℃的患者例数差异无统计学意义。LC组手术时间优于SILC组(P0.05),SILC组术后疼痛评分、肠道蠕动恢复时间、术后切口感染及脂肪液化率、术后住院时间优于LC组(P0.05)。结论:急性胆囊炎发作时间小于72 h者可作为SILC的手术适应证。与LC相比,SILC具有创伤小、美容效果好、术后康复快及住院时间短等优点。

Comparative study of single-incision laparoscopic cholecystectomy and traditional laparoscopic cholecystectomy for acute cholecystitis

Objective:To discuss the feasibility of three-point transumbilical single-incision laparoscopic cholecystectomy (SILC) for acute cholecystitis.Methods:The clinical data of patients who underwent laparoscopic cholecystectomy (LC) and SILC for acute cholecystitis from Mar.2016 to Mar.2017 were retrospectively analyzed.Operation time,intraoperative blood loss,intraoperative catheterization rate and indwelling time,pain scores at 6 h after operation,postoperative body temperature,postoperative incision infection and fat liquefaction rate,recovery time of intestinal peristalsis,the postoperative hospitalization time and complications were compared between the two groups.Results:In SILC group,32 operations were performed successfully.In LC group,44 operations were successful.There was one case of biliary leakage in both groups respectively.There were no significant differences between the two groups in the rate of indwelling peritoneal drainage tube and indwelling time,the number of patients whose body temperature were greater than 37.5℃ after operation.Compared with SILC group,the operation time of LC group was shorter (P ＜ 0.05).However,SILC group had advantages over LC group on postoperative pain scores,intestinal peristalsis recovery time,the rate of postoperative incision infection and fat liquefaction,and hospital stay.Conclusions:SILC could be performed for the patients with acute cholecystitis less than 72 h.Compared with LC,SILC is associated with fewer trauma,better cosmetic result,faster recovery and shorter hospital stay.