经右上腹单孔腹腔镜保胆取石术的应用体会

Application of trans-the right upper abdominal single-incision laparoscopic gallbladder-preserving cholecystolithotomy for cholecystolithiasis

目的：探讨经右上腹单孔腹腔镜保胆取石术治疗胆囊结石的可行性及应用价值。方法：2011年3月至2013年3月施行35例经右上腹单孔腹腔镜保胆取石术，针对术后复发及术后并发症进行1—2年的随访。结果：35例手术均荻成功，无结石残留。手术时间平均（47．5±17．5）min，术后患者恢复顺利，无出血、胆漏、胆道感染、腹腔感染、腹腔脓肿等并发症发生。术后住院3—4d。术后随访1—2年，1例结石再发；4例诉右上腹偶尔不适，其他患者无明显不适。结论：经右上腹单孔腹腔镜保胆取石术安全、有效，患者痛苦小、创伤小、康复快，治疗效果好，在严格掌握手术适应证，术中规范操作的前提下，此术式是治疗胆囊结石值得推广、普及的方法，适于美容要求较高、有保胆意愿的患者。

Objective ：To investigate the feasibility and clinical value of trans-the right upper abdominal single-incision laparo- scopic gallbladder-preserving cholecystolithotomy for cholecystolithiasis. Methods：Trans-the right upper abdominal single-incision lapa- roscopic gallbladder-preserving cholecystolithotomy was performed on 35 patients with cholecystolithiasis from Mar. 2011 to Mar. 2013, patients were followed-up for a period of 1-2 years in order to observe the postoperative recurrence and complications. Results ： All oper- ations were completed successfully. No residual calculi were observed after the surgery. The operative time was （47.5 ± 17.5 ） min. Pa- tients recovered well. No complications, such as bleeding, bile leakage, biliary tract infection, abdominal cavity infection, abdominal ab- scess and so on occurred. The postoperative hospital stay was 3-4 d. The 35 patients were followed up for 1 to 2 years. One case was found recurrent calculi. 4 cases complained right epigastric discomfort occasionally, no obvious discomfort for other patients. Conclu- sions：Trans-the right upper abdominal single-incision laparoscopic gallbladder-preserving cholecystolithotomy is safe, effective, painless with the merits of small wound, early recovery, good cosmetic outcomes and therapeutic effect. It is worth to be promoted and popularized if carried out with standard operation and strict indication. It is a good choice for patients with requirements for beauty and gallbladder- preserving