经脐单切口腹腔镜胆囊切除术31例报告

Transumbilical Single-incision Laparoscopic Cholecystectomy: Report of 31 Cases

目的探讨经脐单切口腹腔镜胆囊切除术的安全性及可行性。方法 2010年3月～12月行经脐单切口腹腔镜胆囊切除术31例。围手术期处理及手术原则同传统腹腔镜胆囊切除。经脐旁切口探查腹腔后,置入单孔器械或3个不同长度的trocar,分别置入操作器械。左右手器械在腹腔内交叉操作,顺行切除胆囊。结果 2例中转为传统腹腔镜胆囊切除术:1例为胆囊颈部结石嵌顿、胆囊三角处粘连致解剖困难;另1例为胆囊与十二指肠、大网膜粘连严重,探查后即中转。手术时间平均50.7 min(30～100 min),术中出血量平均27.1 ml(5～100 ml),肠功能恢复时间平均1.3 d(1～2 d),术后住院时间平均2.5 d(1～4 d)。至2011年4月,29例随访1～13个月,平均6.3月,随访率93.5%(29/31),均无腹痛、黄疸等术后胆道相关疾病症状,患者对脐部切口的美容效果均满意。结论经脐单切口腹腔镜胆囊切除术在技术操作上是安全、可行的,但需要掌握相应的手术指征和操作要点。

Objective To investigate the safety and feasibility of transumbilical single-port laparoscopic cholecystectomy（LC）.Methods This study included 31 patients who undewent transumbilical single-port LC in our department from March to December 2010 with the same peri-operative treatments for traditional LC.After abdominal exploration via a paraumbilical incision,we inserted single-port laparoscopic apparatus or 3 trocars in different lengths.Anterograde cholecystectomy was then performed intraabdominally.Results Two patients were converted to traditional LC immediately after abdominal exploration because of stone incarceration and adhesion at the Calot＇s triangle or severe adhesion among the gallbladder,duodenum,and greater omentum.The operation was completed in 50.7 min（30-100 min） with a mean of 27.1 ml intraoperative blood loss（5-100 ml）.The patients had their intestinal function recovered in 1-2 days（mean,1.3 days）,and were discharged from hospital in 2.5 days postoperation（1-4 days）.Up to April 2011,29 of the patients were followed up for 1 to 13 months with a mean of 6.3 months（follow-up rate： 93.5%）,during which no abdominal pain,jaundice,or biliary diseases occurred,and all the patients were satisfied with the cosmetic results.Conclusions Transumbilical single-port LC is feasible and safe technically,but deep understanding on indications and skills of the procedure are required.