经脐单孔针式腹腔镜胆囊切除术326例临床观察

Transumbilical single port needle-laparoscopic cholecystectomy:an analysis of 326 cases

目的 探讨经脐单孔针式腹腔镜胆囊切除术（transumbilical single-port laparoseopic cholecystectomy，TUSPLC）的安全性和可行性。方法 回顾性分析解放军第451医院2010年2～10月应用针式腹腔镜和曲线形器械开展TUSPLC手术326例病人临床资料。结果 301例成功实施TUSPLC，手术平均时间35．5min，出血量平均17．2mL，术后无黄疸、出血和切口感染等并发症。24例因胆囊三角区粘连、炎症、解剖变异和创面大需放置引流中转3孔或4孔腹腔镜胆囊切除术（LC），1例术后4d出现胆囊窝积液行腹腔镜探查引流术治愈。术后随访2周至3个月，脐部切口瘢痕小而隐藏脐凹，无可视瘢痕。结论 术前和术中慎重把握手术适应证，经脐单孔腹腔镜胆囊切除术是安全的，具有明显的美容优点。

Objective To explore the security and feasibility of the transumbilical single port needle-laparoscopic cholecystectomy （TUSPLC）. Methods The clinical data of 326 patients performed TUSPLC used by needle laparoscopie and curved apparatus from February to October 2010 at Chinese People＇s Liberation Army 451 Hospital were analyzed retrospectively. Results Among 326 patients, 301 patients were performed TUSPLC successfully with no operation complication occurred, such as jaundice, hemorrhage and wound infection, etc. The mean operation time was 35.5rain. The mean blood loss was 17.2mL. Other 24 patients were transferred to 3 or 4 port LC because of adherence, inflammation, anatomy variation, large wound area in Calot＇s triangle and necessary drainage. Effusion in the fossa of gallbladder within 4 days after operation happened in one patient who were treated well with laparoscopic exploration and drainage. All patients were followed up from 2 weeks to 3 months. The scars were so small and hidden in the fovea umbilicalis that there were not obviously visible scars on abdominal wall. Conclusion Operators should deal with the surgical indications carefully before and in the operations. TUSPLC is safe and has the aesthetic advantage obviously.