吊线法与三器械法单孔腹腔镜胆囊切除术比较

Comparison of operative techniques in single-incision laparoscopic cholecystectomy： suture-suspension versus three-device method

目的针对单孔腹腔镜胆囊切除术的手术方法，对比总结吊线法及三器械法的临床结果。方法回顾分析2008年6月至2011年11月完成的300例经脐单孔腹腔镜胆囊切除术，其中吊线法200例，三器械法100例，分别对手术时间、术中出血量、术中胆囊三角显露情况、术后疼痛评分、住院时间及并发症等进行对比研究。两组病例在年龄，性别，体质指数及诊断等一般资料上差异无统计学意义（P〉0．05）。结果所有手术均由一位医生完成，吊线组及三器械组在术中出血量为（15．6±9．5）与（16．8±7．4）ml（t=1．266，P=0．207）；术后并发症、切口挫伤：吊线组4例，三器械组2例（P=1．000）；切口渗血：吊线组与三器械组均为2例（P=0．603）。住院时间：吊线组（1．6±0．5）d，三器械组（1．6±0．5）d；差异无统计学意义（t=0．653，P=0．514），手术时间：吊线组（40．5±16．0）min，三器械组（51．5±18．0）min（t=5．381，P=0．000）；胆囊三角显露情况：吊线组197例，三器械组68例（X^2=60．178，P=0．000）；术后疼痛评分：吊线组2．0±1．7，三器械组为3．7±1．6，差异有统计学意义（t=8．324；P=0．000），结果显示吊线法优于三器械法。结论吊线法单孔胆囊切除术是一种安全、经济、易于掌握的单孔腹腔镜胆囊切除方法。

Objective To compare the operative techniques of single-incision laparoscopic cholecystectomy （SILC） via suture-suspension versus three-device method. Methods Retrospective analysis was performed for a total of 300 patients undergoing umbilical single-incision laparoscopic cholecysteetomy from June 2008 to November 2011 at our hospital. The procedures were of suture-suspension （n = 200） and three-device （n = 100）. Operative duration, estimated intra-operative blood loss, exposure extent of Calot＇s triangle, postoperative pain score, hospital stay and complications were compared respectively between two groups. Both groups were matched for age, gender, body mass index （BMI）, diagnoses and American Society of Anesthesiology （ ASA ） class. Results All procedures were completed by the same surgeon. Comparison between two groups showed insignificant differences in blood loss （ mean： （ 15.6 ± 9.5 ） vs （ 16. 8 ±7.4） ml ;t = 1. 266, P = 0. 207 ）, postoperative complications （ number of case, incision contusion ： 4 vs 2, P = 1. 000 ;incision hemorrhage ：2 vs 2, P = 0. 603 ） and hospitalization duration （ mean ： （ 1.6 ±0. 5 ） vs （ 1.6 ±0.5 ） d ; t = 0. 653, P = 0. 514 ）, but significant differences in operative duration （ mean ： （ 40. 5 ± 16.0） vs （51.5±18.0） rain; t=5.381, P=0.000）, postoperative pain （mean： 2.0±1.7 vs3.7 ±1.6 ; t = 8. 324, P = 0. 000） and exposure of Calot＇s triangle （ number of case, 197 vs 68 ; X2 = 60. 178, P = 0. 000）. Thus the suture-suspension method was superior to the three-device counterpart. Conclusion The suture-suspension method of SILC is safe, economic and easy-to-handle in clinical practice.