经脐单一部位三通道腹腔镜胆囊切除术60例报告  

Transumbilical Single-site Three-trocar Laparoscopic Cholecystectomy:Report of 60 Cases

作　　者：马海[1] 李杨[1] 杨玉东[2] 董孟华[1] 沈文来[1] 柯海文[1] 

机构地区：[1]解放军第十五医院普外科,乌苏833000 [2]解放军第273医院普外科,库尔勒841000

出　　处：《中国微创外科杂志》2011年第10期947-949,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨经脐单切口三通道腹腔镜胆囊切除术的疗效。方法 2009年3月～2010年6月对60例胆囊良性疾病行经脐单切口三通道腹腔镜胆囊切除。取脐部上缘15～20 mm弧形切口,在切口深部腹直肌前鞘表面游离出一三角形的区域,建立3个通道并形成倒三角形,将腹腔镜与器械分别置入,分离出胆囊管及胆囊动脉后用10 mm钛夹夹闭离断胆囊管和胆囊动脉,电钩顺行切除胆囊,将胆囊从脐切口取出。结果 60例经脐单切口手术均获得成功,无胆管损伤,无中转开腹及加孔手术。初期30例手术时间40～120 min,平均80.5 min;后期30例手术时间25～50 min,平均30.3 min。术后8～16 h进流质饮食并下床活动。住院时间1.5～3 d,平均2 d。60例随访1～12个月,平均6.5月,未发现胆道残留结石、胆管狭窄及切口感染等并发症。结论经脐单切口三通道腹腔镜胆囊切除术创伤小,恢复快,美容效果佳,疗效满意。Objective To evaluate the efficacy of transumbilical single-site laparoscopic cholecystectomy（LC） with three trocars. Methods From March 2009 to June 2010,60 cases of benign gallbladder disease received LC via a single transumbilical incision.Via a 15-20 mm curved incision around the upper edge of the umbilicus,we cut deeply into the rectus sheath to expose a triangle surface area so that to establish three channels which formed a inverted ＂triangle＂.Then laparoscopic instruments were placed to separate and clip the cystic duct and cystic artery with 10-mm titanium clips,and electric hook was used to resect the gallbladder anterogradely.The gallbladder was then removed from the umbilical incision.Results The procedures were completed in all the 60 cases without bile duct injury nor conversion to open surgery or adding a surgical hole.In the 30 cases who received the operation in an early stage,the operation time ranged from 40 to 120 min（mean,80.5 min）;in the latter 30 cases,the mean operation time was 30.3 min（25-50 min）.All the patients resumed liquid diet and off-bed activities in 8 to 16 hours after the surgery.They were discharged from hospital in 1.5 to 3 days with a mean of 2 days.We followed up the cases for 1 to 12 months（mean,6.5 months）,during which no residual stones,biliary stenosis nor incisional infection occurred. Conclusion Transumbilical single-site laparoscopic surgery is minimally invasive and effective with recovery and good cosmetic results.

关 键 词：经脐单一切口腹腔镜手术 胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]