经脐单孔腹腔镜胆囊切除术42例报告

Transumbilical Single-port Laparoscopic Cholecystectomy:A Report of 42 Cases

目的探讨经脐单孔腹腔镜胆囊切除术的安全性。方法 2010年10月～2012年12月我院行经脐单孔腹腔镜胆囊切除术42例。于脐右缘沿脐孔做长2.5 cm弧形切口,置入通道器建立气腹。采用直针带线自右上腹胆囊体表投照点垂直刺入腹腔,将直针引入体内后,于胆囊底部穿过浆肌层(尽量不穿透全层,以免胆汁外漏),再将直针穿出体外,固定缝线,将胆囊底部提起,便于显露胆囊三角区。置入1把预成形分离钳及可转弯分离钳,解剖出胆囊管及胆囊动脉后,可吸收夹分别夹闭胆囊管和胆囊动脉,普通钛夹夹闭远端胆囊管,离断胆囊管,电钩断开胆囊动脉后,夹住胆囊壶腹部,将胆囊向右侧展开,顺行切除胆囊。结果 2例因为局部解剖不清,改为两孔手术,其余40例均成功。手术时间40～135 min;出血10～50 ml。1例切口感染,其余无并发症发生。除1例合并糖尿病因切口感染延期出院外,其余患者均在术后2 d出院。42例随访,10例随访1年,25例随访3个月,7例随访1个月,患者恢复良好,无不良反应发生,切口美观。结论经脐单孔手术安全可行,只要病例选择适当,使用专用器械完全可以达到传统LC的治疗效果,切口美观,达到无瘢痕目的。

Objective To evaluate the safety of transumbilical single-port laparoscopic cholecystectomy.Methods From October 2010 to December 2012,42 patients underwent transumbilical single-port laparoscopic cholecystectomy in our hospital.We made a 2.5 cm arc incision along the umbilicus,then inserted the TriPort and filled it with CO2 to build pneumoperitoneum.We penetrated an unbent needle with thread into abdominal cavity,passed the needle through the seromuscular layer of the bladder,then drew the needle out of the abdominal wall and fixed the suture.The Calot triangle was exposed after lifting the bottom of the gallbladder.We put in a shaped elastic separating plier and an elastic separating plier which could be curved to dissect the cystic duct and artery,clipped them with absorbable clips,then clipped the distant duct with metal clips.Next,we cut the duct and the artery,and resected the gallbladder.Results 2 cases were converted to the two-port procedure because of anatomical reasons,and other 40 cases of single-port laparoscopic cholecystectomy were performed successfully.The operation time was 40-135 min;the blood loss was 10-50 ml.Except for one case of wound infection,no other complications occurred.Except one case（diabetes patient） of prolonged hospital stay due to wound infection,the other patients were all discharged from hospital 2 days after operation.42 cases were followed up,including 10 cases for 1 year,25 cases for 3 months,and 7 cases for 1 month.All the patients recovered well and the incisions did not negatively affect patients＇ life.Conclusions Transumbilical single-port laparoscopic cholecystectomy is safe and practicable.Compared with the traditional laparoscopic cholecystectomy,we could gain the same therapeutic effect using specialized apparatus if proper cases are selected.The cosmetic results are better than traditional laparoscopic cholecystectomy.