单孔腹腔镜手术20例报告

目的:总结单孔腹腔镜手术的手术经验。方法:回顾分析2011年11月至2011年12月施行的经脐单孔腹腔镜手术的临床资料,其中10例行阑尾切除术,6例行胆囊切除术,胆囊造瘘术、肝囊肿开窗术、肝癌射频消融术、腹壁疝修补术各1例。结果:20例手术均获成功,无一例中转开腹及术后并发症发生。经脐单孔腹腔镜肝癌射频消融术手术时间3 h;首例经脐单孔腹腔镜阑尾切除术手术时间121 min,其后的阑尾切除术手术时间平均55 min;经脐单孔腹腔镜胆囊切除术手术时间平均65 min;巨大肝囊肿单孔腹腔镜开窗术手术时间60 min;腹壁疝修补术90 min。术后平均住院3.5 d,4例胆囊手术患者术后1天出院。结论:单孔腹腔镜手术可实现真正腹壁无疤痕的效果,相对传统腹腔镜手术,其手术时间稍长,存在体内器械相互碰撞、手术空间缺乏、单孔Tri-port密封口漏气等缺点,但随着技术水平的不断提高及手术器械的研发完善,单孔腹腔镜手术会逐渐发展并得到广泛推广。

Experiences of laparoendoscopic single-site surgery : a report of 20 cases

Objective:To discuss experiences of laparoendoscopic single-site surgery.Methods:The retrospective analysis was made on clinical data of laparoendoscopic single-site surgery from Nov.to Dec.in 2011,including transumbilical single-port laparoscopic appendectomy(10 cases),cholecystectomy(6 cases),fistulation of gallbladder(1 case),fenestration of hepatic cyst(1 case),radiofrequency ablation of hepatic cancer(1 case) and abdominal wall hernia repair(1 case).Results:All the operations were successfully performed without conversion to laparotomy,and no post-operative complication occurred.The operative time of radiofrequency ablation of hepatic cancer was 3 h.The first case of transumbilical single-port laparoscopic appendectomy costed 121 min,and mean time of the following appendectomy was about 55 min.The average time of cholecystectomy was 65 min.Fenestration of hepatic huge cyst costed 60 min.And the hernia repair costed 90 min.The mean postoperative hospital stay was 3.5 d,and 4 patients underwent cholecystectomy were discharged 1 day after operation.Conclusions:Laparoendoscopic single-site surgery is safe and feasible.This procedure can implement the effect of no scar on the abdominal wall.Compared with traditional laparoscopic operation,its operative time is longer,and has disadvantages of mutual interference from apparatus in vivo,inadequate operative space,and air leak from sealing single port.With the improvement of technique and research of operative instrument,laparoscopic single-site surgery will gradually develop and be generalized extensively.