上腹部微瘢痕腹腔镜胆囊切除术

目的介绍一种在上腹部无手术瘢痕的腹腔镜胆囊切除新术式。方法沿脐左右缘各做一个10mm的弧形切口，各穿刺10mmtrocar，分别供操作器械和腹腔镜进出，另在右下腹置入直径5mm2[1长抓钳用于牵引，用普通腹腔镜器械和电凝钩完成胆囊切除，最后从脐部取出胆囊。结果共用此法手术32例，平均手术时间50min（30～70min），无中转开腹。其中2例因粘连严重转常规三孔法手术，无出血、胆漏等并发症。术后平均住院时间4d（2～5d）。随访4个月～1．5年，右下腹戳孔愈合良好，脐部看不出手术瘢痕。结论经脐及右下腹人路胆囊切除是可行的，可达到上腹部无手术瘢痕的目的，并且手术难度明显小于经脐三孔法胆囊切除术，值得基层医院推广。

Objective To introduce a novel approach of laparoscopic cholecytectomy without epigastric scar. Methods Two 10mm trocars in umbilicus for a laparoscope and operative instruments and another 5mm trocar in the right lower quadrant for assistant instrument. Results There were thirty-two patients who underwent such operation.Mean operative time was 50 min （ 30-70min ） .All patients had smooth operation without postoperative complicationts.Neither conversion nor drainage Was required among them. Two cases were operated by the normal laparoscopic cholecystectomy due tothe severe adhesion.The postoperative hospitalization was 2-5 days.No epigastric trace could be seen except for well healed incisions at lower abdomen and incision hidden in the umbilecus.All patients were very satisfactory with the cosmentic result after 4-18 months follow up. Conclusion Laparoscopic cholecystectomy can also be performed by shifting trocars to lower abdomen without epigastic scars.