“吊线法”经脐单孔腹腔镜胆囊切除术120例报告

Transumbilical single-incision laparoscopic cholecystectomy using suture suspension:a report of 120 cases

目的：探讨“吊线法”经脐单孔腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）的可行性、安全性、经济性及美容性。方法：回顾分析120例“吊线法”经脐单孔腹腔镜胆囊切除术的临床资料，术中均使用普通腹腔镜器械。结果：116例手术获得成功，成功率96．7％，3例因胆囊三角解剖不清、1例因术中胆囊动脉出血中转为两孔法LC。手术时间30～110min，平均（52．39±11．74）min。术中出血量10～80ml，平均（17．71±8．30）ml。术中均未放置腹腔引流管。术后均无出血、胆管损伤、胆漏、胆管狭窄及脐疝等并发症发生。脐部切口小且隐蔽，美容效果满意，几乎无瘢痕。结论：“吊线法”经脐单孔LC是经济、安全、可行的手术方法，美容效果明显。对于初学者而言，应严格把握手术适应证，明确手术关键步骤，术中准确辨认解剖标志及解剖间隙，以提高手术的成功率及安全性，缩短学习曲线。术中将患者的安全放在首位，解剖层次不清、炎症较重、操作困难时应及时中转开放手术。

Objective：To discuss the feasibility, safety,economy and cosmetology of transumbilical single-incision laparoscopic cholecystectomy using suture suspension. Methods：The clinical data of 120 patients who underwent transumbilical single-incision lapa- roscopic cholecystectomy with suture suspension were retrospectively analyzed. Ordinary laparoscopic instruments were used in all the operations. Results： Operations were performed successfully in 116 cases and the success rate was 96.7%. 4 cases were converted to double-incision laparoscopic cholecystectomy because of unclear anatomy of Calot triangle （3 cases） or bleeding of gallbladder artery during operation （ 1 case）. The operation time was 30 to 110 min, and the average duration was （52.39 ± 11.74） min. The intraoperative hemorrhage was 10 to 80 ml, （ 17.71 ± 8.30） ml on average. Abdominal drainage tubes were not put in any cases. No postoperative complications such as bleeding, bile duct injury, bile leakage, stenosis of bile duct or umbilical hernia occurred. Umbilical incision was small and private, so the cosmetic result was satisfactory with almost no visible scar. Conclusions：Transumbilical single-incision laparo- scopic cholecystectomy with suture suspension is an economical, safe and feasible approach, and its cosmetic outcome is better than ordi- nary surgery, so it is suitable for promotion in primary hospitals. For beginners, the surgical indications should be strictly controlled, and the anatomic landmarks and spaces should be accurately identified during operation, in order to improve the success rate and security of surgery, and shorten the learning curve. The safety of patients should be put in the first place, and laparotomy should be performed if it is difficult to do laparoscopy due to unclear anatomical level or severe inflammation.