完全经脐单孔腹腔镜胆囊切除术的手术方法及技术改进

Operative method and technique improvement of transumbilical single-port laparoscopic cholecystectomy

目的:探讨完全经脐单孔腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的手术方法及技术改进。方法:回顾分析在钟世镇院士提出的胆囊替代定位点理论指导下,开展完全经脐LC 94例的手术方法及技术改进,并复习总结国内相关文献。结果:94例患者中1例因可疑胆囊癌中转开腹3,例因腹腔粘连、肥胖等因素,未明确找到Rouviere沟无法确定胆囊替代定位点而增加戳孔行常规LC。90例顺利完成手术。术后患者均获随访,无胆漏、梗阻性黄疸等并发症发生。患者术后恢复良好,治疗及美容效果满意。结论:经脐单孔LC在技术上是安全可行的,但与传统LC相比,操作难度增加。术者遵循正确的操作原则,操作困难及时增加戳孔或中转开腹,此术式可广泛开展。

Objective： To investigate the operative method and technique improvement of transumbilical single-port laparoscopic cholecystectomy. Methods：The clinical data of 94 patients who underwent transumbilical single-port laparoscopic cholecystectomy were retrospectively analyzed. Results：One patient was converted to open surgery because of suspicious gallbladder cancer,3 underwent classic laparoscopic cholecystectomy because of undetected Rouviere groove.90 patients successfully underwent transumbilical single-port laparoscopic cholecystectomy according to the principle of gallbladder substitution anchor point,these patients were all followed up,no complications occurred,such as bile leakage or obstructive jaundice.All patients recovered well and were satisfied with therapeutic and cosmetic result. Conclusions：Transumbilical single-port laparoscopic cholecystectomy is safe and feasible,but difficult when compared with traditional laparoscopic cholecystectomy.Surgeons should follow correct operative principle,increase port or convert to laparotomy when the procedure is hard to continue.The operation can be widely applied in clinic.