用改良的器械实现腹壁无可见瘢痕的经脐入路腹腔镜胆囊切除术

"Non-Scar" Total Laparoscopic Cholecystectomy through the Transumbilical Approach

目的探讨应用改进的器械以避免脐周围器械和trocar冲突,实现腹壁完全无可见瘢痕的经脐入路腹腔镜胆囊切除术的可行性。方法研制无末端膨大部分、内径分别为3、5mm trocar,其最大直径分别为5、8mm,器械长度较普通腹腔镜器械长5cm。用上述器械完成10例经脐入路内镜胆囊切除术。结果1例因显露困难,将脐部3mm trocar置于右上腹,置入抓钳协助牵引完成手术;其余9例均顺利完成手术。手术时间45-110min,（62±25）min。无术中、术后并发症。术后1周恢复正常工作。除脐部皱褶部位外,腹壁无可见手术瘢痕。术后1-5个月电话随访,病人术后恢复顺利。结论自行研制、改进的器械行经脐入路内镜手术,使脐周围trocar和器械的冲突有所改进,有助于完全经脐完成手术,达到腹壁无可见手术瘢痕的目的。

Objective To investigate the feasibility of ＂non-scar＂ total laparoscopic cholecysteetomy trough the transumbilieal approach by using modified instruments. Methods Trocars （5 and 3 mm in diameter respectively） without the proximal seal system on the sleeves were designed for this procedure. The maximum diameters of the trocars were reduced to 8 and 5 mm respectively. The instruments used in this study were 5 cm longer than commercially available instruments. 10 cases of total laparoscopic cholecystectomy were performed by using the tools. Results All the gallbladders were removed successfully without massive bleeding during dissection. A mini port was placed on the right upper abdomen to assist retraction in one case because of technical difficulty. The mean operation time was （62 ± 25 ） minutes （range, 45 to 110 minutes） in this series. No intra- and postoperative complications occurred. All the patients were satisfied with the abdominal cosmetic results. They were discharged in 48 hours after the operation, and then back to work in a week. Follow-up was available in the patients for 1 to 5 months. None of them showed complication or recurrence during the period. Conclusions The interference between trocars and surgical instruments can be partially avoided by using the modified tools. ＂Non-scar＂ total laparoscopic eholecysteetomy is feasible by using the technique.