胆囊底缝线牵引二孔免夹法腹腔镜胆囊切除术

Two-port clipless laparoscopic cholecystectomy using thread retraction of the gallbladder fundus

目的探讨腹腔镜胆囊切除术的新方法。方法经脐窝上缘弧形切开皮肤1.8～2.5cm,完成气腹后靠近切口左角插入鞘管及腹腔镜,紧贴切口右角插入无损伤钳。将穿刺带线针经剑突下皮肤切口刺入腹腔并穿过胆囊底部浆肌层,经剑突下切口插入5mm鞘管和操作钳,将胆囊底缝线打结成一线环。于右锁骨中线肋缘下刺入多功能拨棒,套住胆囊底部线环向肝脏膈面顶起,使胆囊充分显露。丝线结扎胆囊动脉和胆囊管,自胆囊底部剥离胆囊,胆囊标本经脐孔取出。结果 110例胆囊结石并胆囊炎患者采用该法治疗,97例(88.2%)获得成功。手术时间35～66min,平均44min;胆囊牵引所需时间3～7min,平均4.2min。另13例(11.8%)因分离困难而改为三孔法。全部患者术后无胆瘘、出血等并发症发生。结论该法术中显露满意,操作如同四孔法一样方便,因此,是一种更加微创、实用的腹腔镜胆囊切除术式。

Objective To explore a new method for laparoscopic cholecystectomy. Methods An arc incision of 2.5 cm was made below the upper edge of the umbilicus. After inflation, the 10 mm trocar was inserted at the left side of the incision and a forceps inserted at the right. The gallbladder fundus was lifted by the forceps and sewed by a long needle with a set of silk suture on the tip. After withdrawing the needle, a 5 mm trocar was inserted and the silk suture left in the gallbladder fundus was tied to form a loop. A puncturing stick was inserted at the midclavicular line under right costal margin. The suture loop of the gallbladder fundus was held up by the stick and pushed upward anterior to the liver. With full exposure of the triangle, the cystic artery and duct were easily freed and clipped. Dissection from the fundus was routinely done with the help of the suture retraction. Results One hundred and ten patients with calculous cholecystitis had received this method and 97 cases（ 88.2% ） were successful. The operation time was 35 - 66 min（ average 44 min）. The time consumed by suture retraction of the gallbladder was 3 - 7 min（ average 4.2rain）. The remaining 13 cases（ 11.8% ） were converted to three - port LC because of hard dissection. No bile leak, bleeding and other postoperative complications occurred. Conclusion Suture retraction of the gallbladder fundus is helpful and time - saving in two - port LC.