普通腹腔镜器械经脐单一部位与三孔腹腔镜胆囊切除术的对比研究

Comparison between Transumbilical and Three-port Laparoscopic Cholecystectomy with Regular Equipment

目的探讨普通腹腔镜器械经脐单一部位腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的安全性、可行性及临床价值。方法随意抽取我院2009年8月～2011年8月胆囊良性疾病行经脐单一部位LC及三孔LC各180例。经脐内镜手术(transumbilical erdoscopic surgery,TUES)经脐部单一切口置入3个trocar,采用普通腹腔镜器械;三孔法取剑突下、脐部及右肋缘下切口行LC。比较2组手术时间、术后并发症、手术方式更改率、镇痛药应用、肠功能恢复时间、住院时间及住院费用。结果 2组在手术时间、手术方式更改率、镇痛药应用率、并发症发生率、肠功能恢复时间、住院费用及术后住院时间等方面差异均无显著性(P>0.05)。TUES组1例胆管损伤二次开腹手术。随访1～3个月,无腹痛等不适症状,TUES组腹壁无可见手术瘢痕。结论 TUES与三孔LC相比,具有微创及美容等优势,普通腹腔镜器械下开展经脐单一部位LC手术是安全、有效及可行的,值得临床推广。

Objective To investigate the safety,feasibility and value of transumbilical endoscopic surgery（TUES） and three-trocar laparoscopic cholecystectomy（LC）.Methods From August 2009 to August 2011,360 patients with benign biliary disease were assigned to TUES or three-trocar LC,with 180 cases in TUES or three-port group.In the TUES group,three trocars were placed through a single umbilical incision,and then LC was performed with regular equipments.In the three-ports group,xiphoid,navel and right subcostal incisions were made for inserting the trocars.The operation time,postoperative complications,rate of conversion to open surgery,analgesic consumption,recovery time of gastrointestinal function,hospital stay and cost were compared between the two groups. Results No significant difference was detected in the operation time,rate of conversion to open surgery,analgesic consumption,rate of postoperative complications,and hospital stay and cost between the two groups（all P0.05）.In the TUES group,one patient received a second operation by open surgery because of biliary injury.The patients were followed up for 1 to 3 months,during which no abdominal pain or other symptoms were complained.In the TUES group,no surgical scar was visible.Conclusions TUES is superior to three-port LC because of less invasion and better cosmetic results.TUES with regular equipment is safe,feasible and effective.