经脐单孔腹腔镜胆囊切除术的临床推广探讨

The exploration of trans-umbilicus single-port laparoscopic cholecystectomy for clinical generalization

目的探讨经脐单孔腹腔镜胆囊切除术(TUSPLC)的适应证及推广价值。方法回顾性分析2010年5～12月确诊为无严重胆囊炎症的胆囊息肉或胆囊结石56例患者的临床资料,随机分为两组,一组行TUSPLC(TUSPLC组),另一组四孔法行腹腔镜胆囊切除术(LC组),其中TUSPLC组26例,LC组30例。比较两组手术时间、术中出血量、术后镇痛、术后住院时间及术后并发症发生率。结果 TUSPLC组23例顺利完成手术,3例中转行LC。LC组均顺利完成手术。TUSPLC组与LC组手术时间分别为(52.45±10.84)min和(39.29±8.61)min(t=5.0601,P=0.0000);术中出血量分别为(19.32±5.69)ml和(22.17±6.27)ml(t=1.7703,P=0.0823);术后需镇痛分别为1例和6例;术后住院时间分别为(2.27±1.37)d和(3.57±1.16)d(t=0.7396,P=0.4628);两组术后均无出血、胆漏、胆管损伤等并发症发生。结论 TUSPLC与常规LC相比安全、可行,具有疤痕不明显且隐蔽、术后疼痛轻、恢复快等优点,在胆囊切除中占有一席之地。但对术者技术和设备要求较高。

Objective To explore the indication and generalization value of trans-umbilicus single-port laparoscopic cholecystectomy（TUSPLC）.Methods Retrospectively analyzed the clinical data of 56 patients with gallbladder polypus or stone without severe cholecystitis in our hospital from May to December 2010.They were divided into two groups at random,26 cases of single-port group and 30 cases of routine group.The operating time,operative blood loss,number of cases needed post-operative analgesia,hospital stay and complication morbility of the two groups were compared respectively.Results 23 cases of the single-port group successfully underwent TUSPLC,while 3 cases were converted into routine laparoscopic cholecystectomy（LC）,30 cases of routine group successfully underwent LC.Of the single-port group and the routine group,the operating time was（52.45 ± 10.84）min vs（39.29 ± 8.61） min（t = 5.0601,P = 0.0000）,operative blood loss was（19.32 ± 5.69） ml vs（22.17 ± 6.27） ml（t = 1.7703,P = 0.0823）,number of cases needed post-operative analgesia was 1 vs 6（χ2 = 8.4125,P 0.01）,the hospital stay was（2.27 ± 1.37） d vs（3.57 ± 1.16） d（t = 0.7396,P = 0.4628）.Nopost-operative complications occurred such as bleeding,bile leakage,bile duct injury,etc.Conclusions TUSPLC has the same safety and feasibility as routine LC.This procedure has the advantages of not obvious and hidden scar,less postoperative pain,quicker recovery.Deserving broadly used in clinical,but need higher requirement of the operator＇s technique and instrument.