脐周三套管技术经脐入路腹腔镜胆囊切除术

Peri-umbilical three trocar technique in transumbilical laparoscopic cholecystectomy

目的尝试应用脐周三套管技术实现腹壁完全无可见瘢痕的经脐入路腹腔镜胆囊切除术。方法64例胆囊疾病（胆囊息肉13例,胆石症51例）患者行经脐入路腹腔镜胆囊切除术。沿脐周呈倒三角形置入2只经改进的直径为5mm的操作套管和1只普通的直径为5mm的套管。分别置入5mm腹腔镜和加长的操作器械完成经脐入路胆囊切除。结果62例患者顺利完成经脐入路胆囊切除术。2例因操作困难,术中见解剖结构不清而中转行常规腹腔镜手术。手术时间为25~65min,平均为（36±32）min。所选患者均未放置引流管。术后除脐部皱折部位外,基本无可见的腹壁瘢痕,且无出血、胆漏等并发症发生。结论应用脐周三套管技术行经脐入路腹腔镜胆囊切除术可以减少脐周各操作器械之间发生的外部冲突,使该技术的操作难度大为降低。

Objective To use peri-umbilical three trocar technique for scar-free transumbilical laparoscopic cholecystectomy. Methods Transumbilical laparoscopic cholecystectomy was performed in patients with gallbladder polyps （13 cases） and gallstones （51 cases）. Three 5 mm trocars （including two improved trocars and one conventionally trocar） were introduced into the abdomen transumbilically. Results The gallbladders were successfully removed in all patients without intra-or post-operative bleeding or bile leakage, except that two technically difficult cases were converted to conventional laparoscopic surgery. The mean operating time was 25-65 min in our group, averaging （36±32） min. All the patients were satisfied with the abdominal cosmetic results. Conclusions The external interference between trocars and instruments can be partially avoided by using the title technique. Total transumbilical laparoscopic cholecystectomy is made feasible by this technique.