经脐单孔腹腔镜胆囊切除及应用3D腹腔镜的临床分析

Clinical analysis of transumbilical single-port laparoscopic cholecystectomy and the application of 3D laparoscopy

目的探讨经脐单孔腹腔镜胆囊切除的操作体会及3D腹腔镜的临床应用。方法我院2012-04~2014-06行经脐单孔腹腔镜胆囊切除术（transumbilical single-port laparoscopic cholecystectomy,TUSLC）59例,其中应用3D腹腔镜6例。在脐下缘切弧形切口2.5 cm,置入三通道Trocar,左侧10 mm孔为主操作孔,右侧5 mm孔为辅助操作孔。解剖、分离胆囊三角,使用Hem-o-lok结扎锁、钛夹夹闭胆囊管及动脉,顺逆结合将胆囊自胆囊床分离、切除。结果 2例因结石嵌顿胆囊壁炎性水肿转为常规LC,1例因胆囊萎缩中转开腹,56例（其中包括应用3D腹腔镜6例）顺利完成手术。平均手术时间62.3 min,平均出血量53.6 ml,术后随访6个月,均无腹痛、发热、黄疸、胆漏等并发症。结论 TUSLC操作可行、安全,美容效果满意,应用3D腹腔镜利于手术操作,手术安全。

Objective To investigate the operation experience of transumbilical single-port laparoscopic cholecystectomy（ TUSLC） and the application prospect of 3D laparoscopy. Methods The clinical data of 59 patients treated by TUSLC were analyzed. At the lower edge of umbilicus,the 2. 5 cm curved incision was made for three-channel Trocar,including 10 mm main port at left side and 5 mm auxiliary one at right side. After dissecting and isolating the Calot triangle,the cystic duct and artery were clipped with Hem-o-lok and titanic clips. The gallbladder was removed integrallty. Results Of 59 cases,56 were performed successfully by TUSLC（ including 6 cases by SD laparoscopy）,and the other 3 cases were converted to three-port or open cholecystectomy. The average operation time was 62. 3 min and the blood loss was 53. 6 ml. No pain,fever,jaundice and biliary leakage were found in the follow-up 6 months. Conclusion TUSLC procedure is feasible and safe with satisfied cosmetic results. The 3D laparoscopy will be safe and more easy for surgical operation.