经脐单孔腹腔镜技术在肝胆外科疾病治疗中的应用

The application of transumbilical single-incision laparoscopic surgery in hepatobiliary diseases

目的探讨经脐单孔腹腔镜技术在肝胆外科疾病治疗中的安全性和可行性。方法分析总结我院2010年5月至2011年5月应用单孔腹腔镜技术选择性对71例患有肝胆疾病患者的手术资料,其中胆囊结石39例,胆囊息肉15例,肝囊肿14例,肝癌1例。结果 69例患者均成功实施了单孔手术,2例胆囊结石患者,由于局部粘连较重,改常规腹腔镜手术。行胆囊切除54例,手术时间45～95 min;肝囊肿14例,行囊肿开窗术手术时间25～45 min;左肝外叶边缘肝癌1例,行肝楔形切除术,手术时间145 min。术后无黄疸、胆汁漏、出血和切口感染等并发症。脐部切口瘢痕小而隐蔽,无明显可视瘢痕。结论在现有条件下单孔腹腔镜手术操作难度较大,术前和术中慎重把握手术适应证,及时改变手术方法,对多数患者经脐单孔腹腔镜手术是安全的,具有极好的美容效果。

Objective To evaluate the clinical security and feasibility of the transumbilical single-incision laparoscopic surgery in hepatobiliary diseases.Methods 71 cases of transumbilical single-incision laparoscopic surgery performed between May 2010 and May 2011 in the department of general surgery affiliated to Siping center hospital were analyzed.39 patients were diagnosed with cholecystolithiasis,15 patients were diagnosed gallbladder polypus,14 patients were diagnosed with hepatic cyst,and 1 with hepatocellular carcinoma.Results The transumbilical single port laparoscopic cholecystectomy of 69 cases were completed successfully while 2 cases were converted to routine laparoscopic cholecystectomy due to difficulties in operation.69 successful cases include 54 cases of laparoscopic cholecystectomy,14 cases of laparoscopic fenestration in hepatic cyst,and 1 case of laparoscopic partial hepatectomy.There were no postoperative complications such as jaundice,bile leakage,bleeding,wound infection occurred.All cases showed a small or invisible scar.Conclusion Now the transumbilical single-incision laparoscopic surgery is a difficult procedure,Patients should be selected carefully to complete the procedure,The technique results in superior cosmesis.