单孔腹腔镜逆行胆囊切除术的临床疗效

吴硕东; 姚殿波; 韩金岩; 吕超

doi:10.3760/cma.j.issn.1673-9752.2014.09.005

摘要: 目的:探讨单孔腹腔镜逆行胆囊切除术的临床疗效。
方法:回顾性分析2009年5月至2012年12月中国医科大学附属盛京医院收治的979例胆囊疾病患者的临床资料。其中2009年收治 51例、 2010年收治265例、2011年收治374例、2012年收治289例。术前准备同多孔LC。手术时，选择脐部正中切口，行单孔腹腔镜逆行胆囊切除术。游离胆囊体和底部后，游离、拉直胆囊管，与胆总管呈垂直， 2枚hemolock夹钳夹胆囊管近端后，超声刀凝切胆囊管，切除胆囊。术后护理同多孔LC。采用电话和门诊随访，随访患者切口感染、切口疝、切口疼痛、切口美观满意度等，随访时间截至2013年3月。
结果:979例患者无中转开腹手术，20例患者因炎症较重中转为多孔LC，〖JP3〗其中2009年3例(5.88%)，2010年5例(1.89%)，2011年5例(1.34%)，2012年7例(2.42%)。959例患者平均手术时间为48.5 min，术中出血量为(27±25)mL。其中2009年、2010年、2011年、2012年的平均手术时间分别为51.8 min、49.2 min、48.9 min、 46.7 min，术中出血量分别为35.0 mL、32.1 mL、33.8 mL、22.9 mL。患者术后疼痛较轻，4.90%(47/959)的患者使用止痛药物，其中2009年5例，2010年12例，2011年18例，2012年12例。959例患者中仅有 4例术后脐部有轻度红肿，经换药治疗后痊愈。2010年至2011年的手术患者中有3例出现胆管损伤，2例术中发现及时修补，1例保守引流后痊愈。患者术后平均肛门排气时间为2.2 d，平均住院时间为4.2 d。 924例患者获得随访，随访时间为1～3个月。随访期间患者术后瘢痕隐藏在脐内，均无切口疝发生。
结论:单孔腹腔镜逆行胆囊切除术安全有效，切口隐蔽。

Abstract: Objective:To investigate the clinical efficacy of transumbilical single incision retrograde laparoscopic cholecystectomy.
Methods:The clinical data of 979 patients with gallbladder diseases who were admitted to the Shengjing Hospital of China Medical University from May 2009 to December 2012 were retrospectively analyzed. The numbers of patients who were admitted in the year of 2009, 2010, 2011 and 2012 were 51, 265, 374, 289, respectively. The preoperative preparation of transumbilical single incision retrograde laparoscopic cholecystectomy was similar to that of traditional multi portal laparoscopic surgery. During the operation, the umbilical incision was selected. After the body and bottom of the gallbladder was dissociated, the cystic duct of gallbladder was dissociated and straightened, which was vertical to the common bile duct. After clipping the proximal part of the cystic duct of gallbladder with 2 hem o lock clips, the cystic duct was cut off with the ultrasonic knife, and then the gallbladder was removed. Postoperative nursing was also similar to that of traditional laparoscopic cholecystectomy. Patients were followed up via phone call or out patient examination till March 2013. The wound infection, incisional hernia, incisional pain, cosmetic benefits were observed.
Results:No patient was converted to open surgery. Twenty patients were converted to multi portal laparoscopic cholecystectomy because of severe inflammation (3 patients in 2009, 5 in 2010, 5 in 2011 and 7 in 2012). The mean operation time and volume of blood loss of the 959 patients were 48.5 minutes and (27±25)mL. The operation time in 2009, 2010, 2011 and 2012 were 51.8 minutes, 49.2 minutes, 48.9 minutes and 46.7 minutes. The volumes of blood loss in 2009, 2010, 2011 and 2012 were 35.0 mL, 32.1 mL, 33.8 mL and 22.9 mL, respectively. The postoperative pain was slight. Forty seven patients were administered antalgesics (5 in 2009, 12 in 2010, 18 in 2011 and 12 in 2012). In the 959 patients, umbilical swelling occurred in 4 patients, and was cured by disinfection treatment. Bile 〖HJ*6〗duct injury occurred in 3 patients from 2010 to 2011, timely repair wad done in 2 patients, and 1 was cured by drainage. The mean time of postoperative exhuast time and duration of hospital stay were 2.2 days and 4.2 days. A total of 924 patients were followed up for 1 -3 months. The scar was hidden in the navel, and no incisional hernia occurred.
Conclusion:Transumbilical single incision retrograde laparoscopic cholecystectomy is safe and effective with cosmetic benefits.

单孔腹腔镜逆行胆囊切除术的临床疗效

Clinical efficacy of transumbilical singleincision retrograde laparoscopic cholecystectomy