经脐单孔与常规腹腔镜胆囊切除术比较分析

目的探讨经脐单孔腹腔镜胆囊切除术的优越性。方法选择2009年3至8月间收治的60例行腹腔镜胆囊切除术的患者,随机分成两组。30例行经脐单孔腹腔镜胆囊切除术（单孔组）,其中胆囊息肉19例,胆囊结石11例;平均病史1～2年,无急性炎症;于脐部做一1.5～1.8cm弧形切口,应用与常规腹腔镜胆囊切除术相同的方法建立腹腔镜操作通道并维持气腹完成胆囊切除。30例行常规（三孔或四孔法）腹腔镜胆囊切除术（常规组）,其中胆囊息肉5例,胆囊结石15例,胆囊炎10例;平均病史2～3年,无急性炎症。结果所有手术均获成功。单孔组除第1例手术时间为60min外,其余29例平均手术时间为20～40min;均未放置引流管,无出血及胆漏等并发症发生,患者清醒后即可饮水,2～3d出院,术后两周复查,脐部无明显手术瘢痕。常规组平均手术时间为40min,5例放置引流管,无明显出血及胆漏等并发症发生,平均术后5d出院,脐部及上腹部手术瘢痕明显。结论经脐单孔腹腔镜胆囊切除术是安全可行的,但操作难度较常规腹腔镜胆囊切除术大,脐部操作装置及手术器械有待进一步完善和改进,但较常规腹腔镜胆囊切除术更加微创,极具推广价值。

The analysis of transumbilical single-port laparoscopic cholecystectomy compare with conventional laparoscopic cholecystectomy

Objective To explore the superiority of transumbilical single-port laparoseopie eholeeysteetomy. Methods Thirty patients with gallbladder diseases （19 patients with gallbladder polyps, 11 cases of gallstone）undergoing transumbilieal single-port laparoseopie choleeysteetomy, 1.5-1.8 em curved incision was cut along the edge of the navel. Thirty patients （5 cases of polyps, 15 eases of stones, 10 cases of eholecystitis） were treated with the conventional laparoseopie choleeystectomy. Results All the operations were successfully performed. The first case operation time of transumbilieal single-port laparoscopic choleeystectomy lasted for 60 min,the following cases were 20-40 min. No drainage tube was placed and postoperative bleeding and bilialy leakage. The mean time of hospitalization was 2-3 days. There was no visible scar on the abdominal wall after postoperative 2 weeks. The average operation time of conventional laparoscopic cholecystectomy was 50 min, 5 drainage tubes was placed but postoperative bleeding and biliary leakage didn＇t occur.The mean time of hospitalization was 5 days. There was obvious surgical scar on the abdominal wall. Conclusions Transumbilical single-port laparoscopic cholecystectomy is a safe and feasible operation, but the operation is more difficult than conventional laparoscopic cholecystectomy. Umbilical operation device and surgical instruments would be further refined and improved, but it is minimally invasive than conventional laparoscopic cholecystectomy.It is highly promotional value, and expected to be a promising new type of laparoscopic cholecystectomy.