经脐单孔腹腔镜与常规腹腔镜胆囊切除术的临床研究

Clinical study of transumbilical single port laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy

目的观察经脐单孔腹腔镜胆囊切除术(TUSPLC)与常规腹腔镜胆囊切除术(LC)的治疗效果。方法采用回顾性分析方法选择2010年10月至2014年10月319例符合入选标准的胆囊结石、胆囊息肉患者,以159例行经脐单孔腹腔镜胆囊切除术(TUSPLC)者为观察组,160例行常规三孔腹腔镜胆囊切除术(LC)者为对照组,采用手术时间、术中出血量、术后住院时间、使用止痛药的次数、并发症的发生率指标评价两种手术方法的治疗效果。结果观察组156例顺利完成TUSPLC手术,1例因左肝叶肥厚影响视野中转行常规LC,1例因胆囊动脉滑脱出血中转行常规LC,1例因高度怀疑胆囊癌直接中转开腹行胆囊切除术。对照组158例完成常规LC手术,1例因胆总管损伤中转开腹完成手术,1例因高度怀疑胆囊癌中转开腹完成手术。两组患者手术时间、术中出血量、使用止痛药的次数、术后并发症发生率比较差异均无统计学意义(P均>0.05),观察组术后住院时间明显长于对照组(P<0.05)。结论 TUSPLC与常规三孔LC相比同样安全、可靠,且美容效果好,但在术后疼痛、术后住院时间方面并没有明显的优势,而且对术者的技术要求较高。

Objective To observe the efficacy of transumbilical single port laparoscopic cholecystectomy （TUSPLC） and conventional laparoscopic cholecystectomy （LC）. Methods A total of 319 patients with gallstones and gallbladder polyps between October 2010 and October 2014 were enrolled in this study. The patients who underwent TUSPLC were classified as observation group （n = 159）, and the other patients who underwent LC were classified as control group （n = 160）. The therapeutic effects of two operational methods were assessed based on operating time, intraoperational blood loss, postopera- tive hospital stay, frequency of analgesics use, incidence of complications. Results Out of 159 cases in observation group, TUSPLC was successfully completed in 156 cases and was switched to three holes LC in 1 case due to the poor vision caused by left hepatic lobe hypertrophy and in 1 case due to cystic artery detachment bleeding and was directly switched to open cholecystectomy in 1 case due to highly suspected gallbladder carcinoma. Out of 160 cases in control group, conven- tional LC was completed in 158 cases and was switched to open cholecystectomy in 1 case due to common bile duct injury and in 1 case due to highly suspected gallbladder carcinoma. There were no significant differences in operating time,intrao- perational blood loss, frequency of analgesics use and incidence of complications between two groups（ all P 〉 0.05 ）. There was significant difference in average postoperative hospital stay （ P = 0. 010 ）. Conclusions Compared with conventional LC,TUSPLC is equally safe,reliable and better cosmetic effects,but it hasn＇t superior in the indexes of postoperative pain and postoperative hospital stay. In addition, its technical requirement is higher for the surgeons.