Single-incision vs three-incision laparoscopic cholecystectomy for complicated and uncomplicated acute cholecystitis

AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital.One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes,straight instruments,and conventional ports.Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded.The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings.Patient demography,clinical data,operative results and complications were recorded and analyzed.RESULTS:Fifty patients with gangrenous cholecystitis,gallbladder empyema,or hydrops were classified as the complicated group,and 58 patients with acute cholecystitis were classified as the uncomplicated group.Twenty-three(46.0%)of the patients in the complicated group(n=50)and 39(67.2%)of the patients in the uncomplicated group(n=58)underwent SILC;all others underwent 3ILC.The postoperative length of hospital stay(PLOS)was significantly shorter in the SILC subgroups than the 3ILC subgroups(3.5±1.1 d vs 4.6±1.3 d,P<0.01 in the complicated group;2.9±1.1 d vs 3.7±1.4 d,P<0.05 in the uncomplicated group).The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups,but the difference reached statistical significance only in the uncomplicated group(37.41±0.56℃vs 37.80±0.72℃,P<0.05 on postoperative day 1;37.10±0.43℃vs 37.57±0.54℃,P<0.01 on postoperative day 2).The operative time,estimated blood loss,postoperative narcotic use,total length of hospital stay,conversion rates,and complication rates were similar in both SILC and 3ILC subgroups.The complicated group had longer operative time(122.2±35.0 min vs 106.6±43.6 min,P<0.05),longer PLOS(4.1±1.3 d vs 3.2±1.2 d,P<0.001),and higher conversion rates(36.0%vs 19.0%,P<0.05)compared with the uncomplicated group.CONCLUSION:SILC is safe and efficacious for patients with acute cholecystitis.The main benefit is a faster recovery than that achieved with 3ILC.

经膀胱途径单孔腹腔镜下前列腺癌根治术治疗局限性前列腺癌8例报告

目的探讨经膀胱途径单孔腹腔镜下前列腺癌根治术（transvesical single．sitelaparo．scopic radical prostatectomy，TVSSLRP）的手术技巧和疗效。方法选取2010年11月至2011年5月局限性前列腺癌患者8例。年龄37～65岁，平均58岁。体质指数（body mass index，BMI）20．0～26．0kg／m。，平均22．5kg／m2。术前PSA0．98～10．04μg／L，平均7．50μg／L。国际勃起功能指数（IIEF-5）≥21分7例，〈21分1例。术前穿刺活检病理TNM分期T1a期3例，T2a期5例。Gleason评分2＋2分4例，3＋2分3例，3＋3分1例。D’Amico风险分层均为低风险。全麻下行TVSSLRP，手术由同一名术者完成。使用自制3通道单孔套管建立气膀胱操作通道。远离输尿管开口切开膀胱颈后缘，分离并切断双侧输精管，游离双侧精囊，切开狄氏筋膜，分离前列腺后壁。沿前列腺两侧做环形切口方便暴露前列腺侧韧带，筋膜内层面保留两侧阴茎勃起神经血管束。沿前列腺两侧游离至耻骨后，紧贴前列腺表面切断耻骨前列腺韧带，推开耻骨后血管复合体，分离前列腺尖部，切断尿道。为减少膀胱尿道吻合张力，在膀胱颈两侧和6点处切开膀胱黏膜及黏膜下层，用V—LocTM免打结缝线行膀胱尿道吻合。结果本组8例TVSSLRP均顺利完成，无增加辅助通道。手术时间75～180min，平均125min。术中出血量85—450ml，平均140ml，无输血患者。术中无手术并发症发生。术后病理检查分期pT：。期3例，pT2b。期4例，pT2a。期1例；Gleason评分2＋2分2例，3＋2分4例，3＋3分2例；手术切缘均阴性。术后拔除尿管时间9～16d，平均14d，拔管后控尿均满意，无尿失禁。住院天数13～25d，平均17d。术后随访12—18个月，平均14个月，无尿道狭窄和生化复发发生。术后6个月5例患者勃起功能满意，IIEF-5≥21分。结论经膀胱途径单孔腹腔镜下前列腺癌根治术能有效保护阴茎勃起神经和控尿神经，肿瘤根治疗效好。