改良两孔法腹壁微小瘢痕的腹腔镜胆囊切除术的手术技巧

Surgical techniques of improved two-port laparoscopic cholecystectomy with tiny scar

目的 探讨使用常规腹腔镜器械进行改良两孔法腹壁微小瘢痕的腹腔镜胆囊切除术的手术技巧及安全性.方法 对634例胆囊良性疾病的患者施行使用常规腹腔镜器械进行改良两孔法腹壁微小瘢痕的腹腔镜胆囊切除术（改良组）,同期进行常规三孔法腹腔镜胆囊切除术（LC组）152例,比较两组的手术时间、术中出血量、术后恢复等情况.结果 改良组有11例因肝左叶肥大及胆囊三角显示不清改为三孔法,其余623例患者顺利完成改良两孔法腹壁微小瘢痕的腹腔镜胆囊切除术,两组均无中转开腹、无出血、胆漏、胆道损伤等并发症,两组在手术时间,术中出血量,术后下床时间及进食时间差异无统计学意义（P＞0.05）,但改良组切口美容效果好（P＜0.05）.结论 改良两孔法腹壁微小瘢痕的腹腔镜胆囊切除术安全可行,术后手术瘢痕微小,可以适用于绝大部分的胆囊良性疾病的腹腔镜胆囊切除术.

Objective To evaluate the surgical techniques and safety of improved two-port lap aroscopic cholecystectomy with tiny scar by using conventional laparoscopic instruments.Method In accordance with the wishes of the patients,634 cases of benign gallbladder disease in our department from September 2010 to June 2013 were treated with improved two-port laparoscopic cholecystectomy with tiny scar by using conventional laparoscopic instruments （improved group）.Another 152 patients at the same period were treated with conventional three-port laparoscopic cholecystectomy （LC group）for comparison.Operative time,intraoperative blood loss and postoperative recovery were analyzed by t-test and x2 test.Results In the improved group,11 patients were converted to the three-port LC due to hypertrophy of the left liver lobe and unclear display of the triangle.The other 623 cases of surgeries were successfully completed without any laparotomy conversion or complications such as bleeding,bile leakage and bile duct injury.There were no significant differences in operative time,intraoperative blood loss,postoperative ambulation time and eating time between the groups （P ＞ 0.05）,but the cosmetic effect in the improved group was more satisfactory（P ＜ 0.05）.Conclusion Improved two-port laparoscopic cholecystectomy with tiny scar is safe and feasible.It has a satisfactory cosmetic effect and can be applied in LC for the majority of benign diseases.