经脐入路腹腔镜胆囊切除术3000例报告  

Transumbilical Single-incision Laparoscopic Cholecystectomy: Experience of 3000 Cases Yu Linhai,Wang Tao,Gu Chunfei,et

作　　者：郁林海[1] 汪韬[1] 顾春飞[1] 方胜利[1] 褚永悦[1] 朱海峰[1] 冯林松[1] 钟诚[1] 

机构地区：[1]上海中医药大学附属曙光医院松江分院外一科,上海201600

出　　处：《中国微创外科杂志》2015年第5期394-397,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨经脐入路腹腔镜胆囊切除术的可行性、安全性。方法回顾性分析2007年11月~2014年9月3000例经脐三套管法腹腔镜胆囊切除术的临床资料,其中胆囊结石2308例,胆囊息肉样病变385例,胆囊结石合并胆囊息肉样病变或胆囊腺肌症307例。使用加长直型腹腔镜器械。结果所有患者均成功完成手术,手术时间8~175 min,前2200例手术时间中位数21 min,后800例为12 min,术中出血2~200 ml,中位数18 ml,术后2~5天出院。手术并发症18例,其中2例因术中胆总管部分损伤中转为三孔腹腔镜手术;1例因胆总管横断伤、1例因术中大出血中转开腹;2例因术后腹腔出血、1例因术后胆漏再次三孔腹腔镜手术;胃浆膜灼伤2例、胆漏6例、切口感染3例保守治疗痊愈。无手术死亡。术后1~46个月复诊,瘢痕隐蔽,患者满意,无切口疝发生。结论用加长直型腹腔镜器械行经脐入路腹腔镜胆囊切除术安全可行,美容效果好。Objective To investigate the feasibility and safety of transumbilical single-incision laparoscopic cholecystectomy . Methods We retrospectively analyzed clinical data of 3000 cases of transumbilical laparoscopic cholecystectomy performed between November 2007 and September 2014.Among them, there were 2308 cases of gallbladder calculi , 385 cases of gallbladder polyp-like lesions, and 307 cases of gallbladder calculi with gallbladder polyp lesions or adenomyosis .Extended straight laparoscopic instruments were applied in the surgery . Results All the procedures were successfully accomplished .The operation time was 8-175 min.The median operation time was 21 min in the first 2200 cases and 12 min in the remaining 800 cases.The median intraoperative hemorrhage volume was 18 ml （range, 2-200 ml）.The patients were discharged 2-5 days after the surgery.A total of 18 cases encountered complications as following：2 cases were given a conversion to 3-trocar procedure due to injury of partial common bile duct （ CBD）;1 case of transaction of CBD and 1 case of mass bleeding required conversions to laparotomy; 2 cases of postoperative intraabdominal hemorrhage and 1 case of bile leakage were handled with a subsequent 3-trocar laparoscopy;2 cases of burning injury in gastric serosa , 6 cases of bile leakage , and 3 cases of port-site infection were managed conservatively .No mortality was observed .The patients were followed up for 1 -46 months after surgery , with satisfactory outcomes and concealed scars .No incisional hernia was identified . Conclusion By using ordinary extended straight laparoscopic instruments , transumbilical laparoscopic cholecystectomy is feasible and safe, and has an excellent cosmetic effect .

关 键 词：腹腔镜胆囊切除术 经脐入路 单一切口 

分 类 号：R657.4[医药卫生—外科学]