经脐入路软镜下胆囊切除术实验研究

Transumbilical endoscopic cholecystectomy on a porcine model

目的探讨经脐孔入路双通道软性内窥镜进行胆囊切除术（transumbilical bi-channel soft endoscopic cholecystectomy,TUEC）的可行性。方法 8只活体猪经脐部腹腔镜套管置入双通道软镜,右肋下置入抓钳抓持胆囊底部协助暴露。利用软性手术器械断离胆囊管和胆囊血管,并剥离胆囊,标本自脐部戳口取出。结果 8只活体猪均顺利完成手术,手术成功率100%。术中出血和术中胆漏各1只。手术时间1.5~3.5 h,并随技术熟练明显缩短。结论经脐入路双通道软镜进行胆囊切除技术上是可行的,如何避免和处理术中出血和胆漏仍须进一步研究。

Objective Investigate the feasibility of transumbilical endoscopic cholecystectomy.Methods Eight pigs were submitted to transumbilical endoscopic cholecystectomy.After establishment of pneumoperitoneum,a bi-channel endoscope was placed through an infra-umbilical trocar.The gallbladder fundus was lifted by a grasper which was inserted right infracostally.The cystic duct was dissected with a flexible hook and clipped by a clip fixing device,and the gallbladder was separated from the liver bed.The specimen was extracted through the umbilical trocar.Results All the cases were performed successfully,one with bleeding and one with bile leakage.The operation time was 1.5 to 3.5 hours and decreased with experience.Conclusion Transumbilcal endoscopic cholecystectomy is feasible and it should be discussed further in how to avoid and deal with bleeding and bile leakage during operation.