常规器械经脐单孔腹腔镜保胆取石术治疗胆囊结石的临床应用

Clinical application of the conventional equipment in transumbilical single-port laparoscopic gallbladder-preserving cholecystolithotomy for cholecystolithiasis

目的：探讨常规器械行经脐单孔腹腔镜保胆取石术治疗胆囊结石的可行性及临床应用价值。方法：2011年1月至2014年12月采用常规器械行经脐单孔保胆取石术21例,术前常规准备,脐部放置倒＂品＂字形3枚Trocar,采用胆道镜网篮取净结石,胆囊切开处用可吸收缝线间断8字缝合,同时术后随访并统计患者胆囊功能恢复情况。结果：2例术中发现胆囊与腹腔粘连严重,胆囊壁色泽不佳后改行单孔腹腔镜胆囊切除术,19例成功完成经脐单孔腹腔镜保胆取石术,手术时间45~120 min,平均（73.1±15.9）min,术后患者均恢复良好,无胆漏、腹腔积液及切口感染等并发症发生。16例患者术后获得有效随访,无胆囊炎症状,1例胆囊结石复发。结论：常规器械行经脐单孔腹腔镜保胆取石术具有创伤小、术后腹壁无明显可见瘢痕、快速康复的优点,同时无需准备特殊手术器械,值得推广应用。

Objective： To investigate the feasibility and clinical value of using the conventional equipment in transumbilical single-port laparoscopic gallbladder-preserving cholecystolithotomy for cholecystolithiasis. Methods： Transumbilical single-port laparoscopic gallbladder-preserving cholecystolithotomy was performed on 21 patients with cholecystolithiasis from Jan. 2011 to Dec. 2014 using conventional equipment. Following the routine preoperative procedures,three Trocars were placed in the umbilicus to establish transumbilical single-port,calculi were removed from the incision of fundus of gallbladder by choledochoscopic stone extraction basket,then an intermittent figure-of-eight suture was used to close the gallbladder incision with absorbable surgical suture. The functional recovery of gallbladder was followed-up after the operation. Results： Two patients were converted to single-port laparoscopic cholecystectomy because of severe adhesion between gallbladder and abdominal cavity and poor color of gallbladder. 19 of 21 patients were operated successfully. The average operative time was（ 73. 1 ± 15. 9） min（ range,45-120 min）,the postoperative recovery was good. No bile leakage,ascites,incision infection or other complications occurred. 16 patients were effectively followed up,no symptoms of cholecystitis were found,and 1 case of recurrent calculi occurred. Conclusions： Transumbilical single-port laparoscopic gallbladder-preserving cholecystolithotomy using the conventional equipment has advantages of small trauma,quick recovery and good cosmetic outcomes. There is no need to prepare special operation equipment,the operation deserves to be recommended in the clinical application.