经脐单孔腹腔镜胆囊切除术的手术经验

Operative experiences on transumbilical single incision laparoscopic cholecystectomy

目的研究经脐单孔腹腔镜胆囊切除术临床可行性及安全性。方法总结2009年2月至2010年12月、82例胆囊疾病患者实施经脐单孔腹腔镜胆囊切除术的经验，并分析手术中碰到的一些疑难问题和应对策略。结果82例患者中，9例患者由于胆囊周围炎症、胆囊三角解剖困难及胆囊动脉结构变异等原因改行其他术式，其中6例改行二孔法腹腔镜胆囊切除术，3例中转常规开放性手术；其余73例手术均顺利完成单孔手术，成功率89．0％。手术时间平均48．4min，手术出血平均20．8ml。术后次日恢复流质饮食，住院3～6d。术后平均随访13．7个月，均无胆管损伤、大出血、切口感染、胆漏、脐疝等并发症发生，术后复查切口愈合良好，瘢痕极隐蔽而不易察觉。结论经脐单孔腹腔镜胆囊切除是安全可行的，技术上的难点容易突破。

Objective To study the feasibility and safety of transumbilical single incision laparoscopic cholecystectomy. Methods Eighty-two cases with gallbladder diseases were underwent with transumbilical single incision laparoscopie cholecystectomy. Some difficulties and countermeasure in operations were analyzed. Results Nine in all patients were converted because of the surrounding inflammation of gallbladder, difficult to dissect in Calot＇s triangulation and variation of gallbladder artery. Of them, 6 cases converted to two-hole laparoscopie cholecystectomy and 3 cases to open operation. Other 73 cases were sueeessfully operated with transumbilical single incision laparoscopic choleeystectomy. The success rate was 89. 0%. The average operative duration was 48.4 rain. The average operative blood loss was 20. 8 ml. Patients returned to liquid food on the first day after operation. Hospital duration was 3 ～ 6 d. During 13.7 months of follow-up, there was no bile duct injury, large bleeding, incision infection, bile fistula and umbilical hernia. The incision healed well. The scar in umbilicus was concealing and difficult to be observed. Conclusions Transumbilical single incision laparoseopic cholecystectomy is safe and feasible. The difficulties in technique are easy to be broken through.