经脐单孔腹腔镜胆囊切除术265例临床观察

Clinical observation of the transumbilical single port laparoscopic cholecystectomy in 265 cases

目的:探讨经脐单孔针式腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的安全性和可行性。方法:2010年2月～9月,应用针式腹腔镜和曲线形器械,采用"一孔一壶腹三管"显露和胆囊三角区"后侧入路"的方法施行265例经脐单孔针式LC。结果:17例因胆囊三角区粘连、炎症、解剖变异和创面大需放置引流,并中转3孔或4孔LC;1例术后4d出现胆囊窝积液行腹腔镜探查引流术治愈;余247例成功实施单孔LC,手术时间平均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发生。术后随访2周～3个月,脐部切口疤痕小且隐藏于脐内,腹壁无可见疤痕。结论:术前和术中慎重把握手术适应证,经脐单孔LC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（LC）. Methods：From Feb.to Sep.2010,265 patients were treated with transumbilical single port needle-LC.The needle laparoscope and curved apparatus were used in those operations.And the method of ＇one port,one ampulla,three ducts＇ and Calot＇s triangle dorsal approach were applied at the same time. Results：Seventeen cases were transferred to 3 or 4 ports LC because of adherence,inflammation,anatomy variation,large wound area in Calot＇s triangle and essential drainage.Hydrops in the fossa of gallbladder within 4 days after operation happened in one case which was successfully treated with laparoscopic exploration and drainage.Other 247 cases were performed single port LC successfully and none operative complications occurred,such as jaundice,hemorrhage or wound infection.The mean operative time was 35.5min,and the mean blood loss was 17.2ml.All patients were followed up from 2 weeks to 3 months.The scars were so small and hidden in the fovea umbilicalis that there was not obviously visible scar on abdominal wall. Conclusions：Operators should carefully deal with the surgical indications before and in the operations.The transumbilical single port needle-LC is safe and has obviously aesthetic advantage.