用普通器械行改良型经脐单部位腹腔镜胆囊切除118例报告

Improved transumbilical single site laparoscopic cholecystectomy with common instruments: a report of 118 cases

目的：探讨用普通器械行改良型经脐单部位腹腔镜胆囊切除术的安全性、可行性及临床价值。方法：回顾分析2010年12月至2013年12月为118例患者使用普通器械行改良型经脐单部位腹腔镜胆囊切除术的临床资料。结果：1例中转为传统三孔法腹腔镜胆囊切除术,余117例手术均获成功,无一例中转开腹及胆道损伤,手术时间45-120 min,平均（50±10）min;术后8-12 h下床活动。其中慢性胆囊炎及胆囊息肉患者术中出血3-5 ml,住院2-4 d,平均（3±1）d,急性胆囊炎出血量25-35 ml,平均（30±5）ml,住院5-7 d,平均（6±1）d。术后随访3-24个月,平均（13±2）个月,无黄疸、腹痛及脐疝发生,脐部切口美观满意度100%。结论：用普通器械行改良型经脐单部位腹腔镜胆囊切除术具有操作简单、无需特殊器械、安全、有效、微创、美容等优势,值得临床推广。

Objective： To explore the safety,feasibility and clinical value of improved single-site transumbilical laparoscopic cholecystectomy with ordinary equipments. Methods： A retrospective analysis was made on clinical data of 118 patients who underwent modified transumbilical single site laparoscopic cholecystectomy with common instruments from Dec. 2010 to Dec. 2013. Results： One patient was converted to the traditional three-port laparoscopic cholecystectomy,the remaining 117 operations were all successful,no conversion to laparotomy or bile duct injury occurred,the operation time was 45-120 min,with the average of（ 50 ± 10） min,after 8-12 h patients began to ambulation. For patients with chronic cholecystitis and gallbladder polyps,blood loss was 3-5 ml,the hospital stay was 2-4 d,with the average of（ 3 ± 1） d; for patients with acute cholecystitis,blood loss was 25-35 ml,with the average of（ 30 ± 5） ml,the hospital stay was 5-7 d,with the average of（ 6 ± 1） d. All the patients were followed up for（ 13 ± 2） months（ range,3-24 months）,no jaundice,abdominal pain or umbilical hernia were found,the cosmetic satisfaction rate of umbilical incision was 100%. Conclusions： Improved transumbilical single site laparoscopic cholecystectomy with common equipment is easy,safe,effective and minimally invasive,does no need special instruments,has better cosmetic results,so it is worth the clinical promotion.