常规器械行经脐单孔腹腔镜胆囊切除术

Transumbilical Single-port Laparoscopic Cholecystectomy Using Routine Instruments

目的探讨常规器械行经脐单孔腹腔镜胆囊切除术(transumbilical single-port laparoscopic cholecystectomy,TUSPLC)的安全性和可行性。方法做脐切口约2cm,分别在切口正中穿刺置入10mm trocar,距正中相当于9点处隔开2~3mm穿刺置入5mm trocar,相当于1点处隔开3~5mm穿刺置入10mm trocar,使用常规器械完成TUSPLC。结果40例均以单纯常规器械经脐单孔法顺利完成手术,1例因胆囊三角解剖困难,中转为两孔法腹腔镜胆囊切除术,无中转开放手术。手术时间35~90min,平均57min;出血量5~20ml,平均7ml。无胆管损伤、腹腔内出血、切口感染等手术并发症。术后住院1~3d,平均1.3d,其中12例为日间手术。41例随访6~20个月,平均13.4月,手术瘢痕隐蔽,患者非常满意。结论使用常规器械行TUSPLC对有经验的术者是安全可行的,而且美容效果很好,值得临床有选择地谨慎推广。

Objective To study the feasibility and safety of transumbilical single-port laparoscopic cholecystectomy (TUSPLC) using routine instruments.Methods A lengthwise incision in the umbilicus was made.A 10-mm trocar was inserted into the abdominal cavity through the central incision.A 5-mm trocar was inserted at the 9 o'clock position about 2-3 mm away,and another 10-mm trocar was inserted at the 1 o′clock position about 3-5 mm away,respectively.The TUSPLC was carried out.Results Of the 41 patients,40 underwent TUSPLC using routine instruments and 1 patient was given a conversion to two-port laparoscopic cholecystectomy due to difficulty of cholecystic triangle anatomical dissection.No conversion to open operation was required.The operative time was 35-90 min (mean,57 min),the intraoperative blood loss was 5-20 ml (mean,7 ml),and no complications such as incision infection,intraperitoneal hemorrhage or bile duct injury occurred.All the patients recovered well.The length of postoperative hospital stay was 1-3 days (mean,1.3 days),and there were 12 cases of day surgery.Follow-ups were conducted in the 41 patients for 6-20 months (mean,13.4 months).All the scars were almost invisible,and the cosmetic results were satisfactory.Conclusions TUSPLC using routine instruments is safe and feasible for experienced laparoscopic surgeons.With good cosmetic results,it is worthy of clinical promotion.