常规腔镜器械完全游离脐环经脐单孔腹腔镜胆囊切除术的临床应用

Clinical analysis of transumbilical single-incision laparoscopic cholecystectomy with totally free umbilical ring by conventional instruments

目的 总结常规器械完全游离脐环经脐行单孔腹腔镜胆囊切除术的临床经验,评价其临床效用,探讨其广泛应用的可行性.方法 选择2012年4月至2017年6月间在南通大学附属医院肝胆外科通过常规器械施行的完全游离脐环经脐单孔腹腔镜胆囊切除术500例,对临床资料进行回顾性分析总结.结果 500例患者中487例患者顺利实施经脐单孔腹腔镜下胆囊切除术;3例患者术中中转开腹;10例因操作困难等状况而增加操作孔,其中5例留置引流管.平均胆囊切除时间(Trocar放置后至胆囊剥离时间)由最初的72.3 min缩短至目前的13.2 min,平均出血量<10 ml,术后出现迟发性胆漏3例,技术开展初期出现术后胆红素一过性升高3例;无出血,无Trocar疝.术后平均住院2.1d.随访美容效果显著.结论 使用常规腔镜器械完全游离脐环的经脐腹腔镜胆囊切除术术后疼痛轻、恢复快、切口隐蔽、总体费用低及术后Trocar疝发生率低等特点,适合在各级医院广泛开展.

Objective To summarize the clinical experience of transumbilical single-port laparoscopic cholecystectomy,and evaluate its clinical utility and the feasibility of widely usage.Methods Between April 2012 and June 2017,500 cases who underwent transumbilical single-port laparoscopic cholecystectomy with totally free umbilical ring by conventional instruments were enrolled.The clinical data were retrospectively analyzed.Results A total of 487 patients were successfully completed the operation.In addition,3 cases were converted to open cholecystectomy,10 cases were converted to multi-port laparoscopy and drainage tubes were placed in 5 cases.The mean operating time of transumbilical single-port laparoscopic cholecystectomy(from the Trocars being put to the gallbladders being removed)shortened from 72.3 min to 13.2 min.The average bleeding amount was less than 10 ml.After the operation,3 cases had delayed bile leakage and 3 cases had transient up-regulation of bilirubin at the beginning of the technique.No patients had hemorrhage and Trocar hernia.The average hospital stay of patients was 2.1 days.The cosmetic effect was remarkable during follow-up.Conclusion The transumbilical single-port laparoscopic cholecystectomy with totally free umbilical ring by conventional instruments should be widely carried out in hospitals at all levels because of its minimal postoperative pain,rapid recovery,hidden incision,low costs and low incidence of port-site hernia.