摘要
目的经自然孔道腔镜手术已成为腹腔镜外科领域研究热点之一,但需要单孔多通道穿刺套管等特殊器械,且费用更高,一定程度上限制了这项技术的发展。本研究探讨采用常规的腹腔镜器械经脐三孔法腹腔镜胆囊切除术的可行性、安全性。方法实验组(A组):使用常规的腹腔镜器械,在脐部分别置入3个穿刺套管,其中10 mm穿刺孔1个,5 mm穿刺孔2个,施行腹腔镜胆囊切除术32例;对照组(B组)取同期96例病例,采用传统4孔法完成腹腔镜胆囊切除术。结果所有病例均成功完成腹腔镜手术,无中转开腹。实验组中成功完成30例,另2例病例由于胆囊周围粘连严重,需在剑突下加多一个5 mm穿刺套管完成手术。实验组手术时间39.7±5.2 min较传统腹腔镜组手术时间25.3±3.3 min延长,P<0.01、实验组术后病人对切口美容满意度更高、P<0.01;两组间术中出血量、术后肠道功能恢复时间、术后住院时间、术后止痛药使用比较两组间差异无显著性意义;两组均无胆瘘等严重并发症发生,均在术后1～3 d出院。结论采用常规腹腔镜器械,经自然孔道脐部三孔法行腹腔镜胆囊切除术,对胆囊周围无严重粘连等部分病例安全可行、相对传统腹腔镜胆囊切除术美容效果更好。
Objective To evaluate the clinical efficacy and safety of three-port transumbilical endoscopic cholecystectomy performed using conventional laparoscopic instruments. Methods Thirty-two patients undergoing three-port transumbilical endoscopic cholecystectomy using conventional laparoscopic instruments （group A） with 3 ports around the umbilicus were compared with 96 patients （group B） receiving the conventional 4-port routine endoscopic cholecystectomy. Results All the procedures were successfully completed without conversion to open laparotomy. In group A, the procedures were completed smoothly in 30 cases while 2 cases required another port （5 mm） punctured below the xyphoid due to severe adhesion around the cyst. The median operating time was 39.7±5.2 min in group A, significantly longer than that in group B （25.3±3.3 min, P 〈0.001）, but the patients in group A obtained better cosmetic results （P〈0.001）; the median blood loss, recovery time of postoperative intestine function, length of postoperative hospital stay, and the rate of use of postoperative painkillers were comparable between the two groups. Bile leakage or other postoperative complications occurred in none of cases in the two groups. Conclusion In cases without severe adhesion around the cyct, three-port transumbilical endoscopic cholecystectomy using conventional laparoscopic instruments is a safe and feasible alternative to routine endoscopic cholecystectomy with better cosmtic results.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2013年第7期1097-1098,F0003,共3页
Journal of Southern Medical University
基金
广东省适宜卫生技术推广项目(粤卫2011-108-11号)
关键词
腹腔镜
胆囊切除术
经脐手术
laparoscopy
cholecystectomy
transumbilical surgery
