单切口腹腔镜胆囊切除术在胆囊日间手术的应用

Application of single incision laparoscopic cholecystectomy in day surgery

目的探讨单切口腹腔镜胆囊切除术在胆囊良性疾病日间手术中的应用价值。方法回顾性分析2017年3月至2018年12月期间在郑州大学附属郑州中心医院日间手术中心实施的105例单切口腹腔镜胆囊切除术患者的临床资料。结果105例胆囊良性疾病患者均在日间手术中心成功接受经脐单孔腹腔镜手术,其中胆囊结石65例,胆囊息肉26例,胆囊腺肌症14例;男45例,女60例。无一例增加切口或中转开腹。术中均未放置腹腔引流管,术中无胆囊分离时破裂、无胆管损伤及腹腔内出血。手术时间20~95 min、(55.0±25.5)min;术中出血量5~20 mL、(10.3±3.5)mL。全部患者术后在医院过夜后(不超过24 h)出院,术后无切口感染,无延期出院及术后再入院患者,无腹腔内出血、胆管损伤、胆漏等早期严重并发症。术后第1天疼痛评分1~2分,术后第3天电话随访疼痛评分为0~1分,术后第6个月电话随访美容评分4~5分、(4.5±0.5)分,术后随访1年无脐疝等远期并发症发生,脐部切口疤痕隐蔽,美容效果良好。结论良性胆囊疾病在日间手术中实行单切口腹腔镜胆囊切除术是安全、可行的。

Objective To investigate the value of single incision laparoscopic cholecystectomy in the operation of benign diseases of the gallbladder in day surgery.Method The clinical data of 105 patients underwent the single incision laparoscopic cholecystectomy in the Day Operation Center of Zhengzhou Central Hospital of Zhengzhou University from March 2017 to December 2018 were retrospectively analyzed.Results The single incision laparoscopic cholecystectomies were successfully performed in 105 patients with benign gallbladder diseases,including 65 cases of gallbladder stones,26 cases of gallbladder polyps,14 cases of gallbladder adenomyosis;45 cases of men and 60 cases of women.In all cases,no incision was increased or no case was converted to laparotomy.No bile duct injury and intraabdominal bleeding happened during the operation.All patients were discharged overnight(no more than 24 h)after the surgery and without delayed discharge and re-admission.The intraoperative blood loss was(10.3±3.5)mL,and the operation time was(55.0±25.5)min(from laparoscopy to gallbladder removal).The postoperative pain score was 1–2 and 0–1 on day 1 and on day 3 after the surgery,respectively.The postoperative incision cosmetic satisfaction score on month 6 after the operation was 4.5±0.5.Conclusion Single incision laparoscopic cholecystectomy is safe and feasible for benign gallbladder disease during day surgery.