“缝线悬吊减鞘卡法”单孔腹腔镜胆囊切除术1118例报告

Gallbladder Suture Suspension and Reducing Trocar Technique in Single-Incision Laparoscpic Chole-cystectomy:1118 Cases Report

目的探讨“缝线悬吊减鞘卡法”单孔腹腔镜胆囊切除术(single-incision laparoscopic cholecystectomy,SILC)的安全性、可行性及效果。方法回顾性分析2012年1月至2020年6月我院行经脐SILC的1118例患者的临床资料,均为胆囊良性疾病,其中胆囊结石伴慢性胆囊炎847例(75.76%),急性胆囊炎伴胆囊结石71例(6.35%),胆囊结石合并胆囊息肉69例(6.17%),胆固醇息肉102例(9.12%),胆囊腺肌症17例(1.52%),胆固醇沉积症12例(1.07%)。结果1118例患者中,成功完成SILC 909例,总完成率81.31%,194例因胆囊炎症壁厚粘连、胆囊萎缩、局部肝叶增生、肝硬化门脉高压症等因素致胆囊三角显露困难而加孔完成手术,15例因致密粘连中转开腹。本组术中发生胆道并发症3例,其中1例因胆囊管汇入右肝管解剖时右肝管热损伤致胆漏,2例胆囊床迷走胆管损伤造成胆汁渗漏,均经引流后好转出院。1例结肠壁浆膜损伤,1例十二指肠球部损伤,20例脐部切口周围淤血。所有患者无术中严重出血、皮下气肿、术后切口疝等并发症。结论“缝线悬吊减鞘卡法”行SILC可最大限度地减少器械之间碰撞干扰,利于术中观察及操作,安全可行,易于操作,适合具有腹腔镜技术的医院开展。

Objective To explore the safety,feasibility and effect of gallbladder suture suspension and reducing trocar technique in single-incision laparoscopic cholecystectomy(SILC).Methods The clinical data of 1118 cases with benign gallbladder diseases who underwent transumbilical SILC with gallbladder suture suspension and reducing trocar technique in our department from January 2012 to June 2020 was analyzed retrospectively,including 847 cases(75.76%)of gallstones with chronic cholecystitis,71 cases(6.35%)of acute cholecystitis with gallstones,69 cases(6.17%)of gallstones with gallbladder polyps,102 cases(9.12%)of cholesterol polyps,17 cases(1.52%)of gallbladder adenomyosis and 12 cases(1.07%)of cholesterol deposition.Results Of the 1118 patients,the SILC was performed successfully in 909 patients with the operating time of(34.5±14.3)min,intra-operative blood loss volume of(9.5±6.0)mL and the success rate of 81.31%.Extra ports were increased to complete the operation in 194 cases due to the difficulty in exposing the Calot's triangle associated with gallbladder inflammation,wall adhesion,gallbladder atrophy,local hepatic lobe hyperplasia,cirrhosis and portal hypertension.And other 15 cases were converted to open surgery due to severe adhesion.During the operation,duct injury was found in 3 cases,including 1 case of bile leak of the right hepatic duct caused by thermal injury and 2 cases of bile leakage caused by the aberrant bile duct injury in the gallbladder bed.Seromembrane injury of colon wall was found in one case,duodenal bulb injury in one case and umbilicushematoma in 20 cases. There was no complication as serious bleeding, subcutaneous emphysema, postoperative incisional hernia and so on. Conclusion The technique of gallbladder suture suspension and reducing trocar is safe and maneuverable in SILC with reducing the collision and interference between instru-ments and facilitating intraoperative observation and operating, and it is recommendated in suitable hospitals with laparoscopic technique.