常规器械经脐入路与传统腹腔镜胆囊切除术的前瞻性随机对照研究  

Transumbilical Single-site Laparoscopic Cholecystectomy with Conventional Devices Versus Traditional Laparoscopic Approach: a Prospective Randomized Controlled Study

作　　者：吴庆华[1,2] 刘玉祥 陈勇 王赭 陈一伟 束一鸣 

机构地区：[1]武警上海市总队医院普外科,上海201103 [2]上海交通大学医学院附属瑞金医院北院普外科,上海201821

出　　处：《中国微创外科杂志》2015年第8期687-691,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：上海市卫计委课题(20134467)

摘　　要：目的探讨使用常规器械行经脐入路单一部位腹腔镜胆囊切除术（transumbilical single-site laparoscopic cholecystectomy,TUSLC）与传统腹腔镜术式（traditional laparoscopic cholecystectomy,TLC）比较的优越性。方法按纳入、排除及剔除标准将武警上海市总队医院2013年9月～2014年3月连续30例非急症腹腔镜胆囊切除术按随机数字表法随机分为TUSLC组（n=14）和TLC组（n=16）。2组性别、年龄和体重指数差异无显著性。比较2组手术相关数据、创伤应激指标及疼痛程度。结果 2组手术时间、术中失血量、手术并发症、术后住院时间、住院总费用及术后各时相创伤应激指标（C反应蛋白、白介素6、中性粒细胞弹性蛋白酶、肿瘤坏死因子α及白细胞）比较差异均无显著性（P〉0.05）。术后12 h TUSLC组疼痛视觉模拟评分较TLC组低（4.00±0.78 vs.4.75±0.68,t=-2.800,P=0.009）,术后24 h及48 h时2组差异无显著性（P〉0.05）。结论常规器械TUSLC安全可行。在手术经验丰富的前提下,此方法较传统术式具有一定的总体优势,即在不增加手术费用的基础上,前者具有美容效果肯定、术后短期内疼痛较轻的潜在微创性特点。Objective To confirm the superiority of transumbilical single-site laparoscopic cholecystectomy （TUSLC） with conventional devices via a comparative analysis of surgical data between TUSLC with conventional devices and traditional laparoscopic cholecystectomy （TLC）. Methods The study prospectively enrolled 30 consecutive elective patients from September 2013 to March 2014 in this hospital. These patients were randomly divided into trial group （TUSLC with conventional devices） （n = 14） and control group （TLC） （n = 16）. Demographic data （including gender constitution, age, and body mass index） between the two groups were not different statistically. Surgical data, post-traumatic stress index, and pain scores between the two groups were compared. Results The surgical data, including operating time, operative blood loss, complications, length of postoperative hospitalization, hospitalization expense, and the post-traumatic stress index per period （ C-reactive protein, interleukin-6, neutrophil elastase, tumor necrosis factor α, white blood cell） were not significantly different between the two groups （ P 〉 0.05 ）. The pain scores of visual analog scale at 24 h and 48 h postoperatively were not significantly different between the two groups （ P 〉 0.05 ）. However, the pain scores at 12 h postoperatively was lower in the trial group than that in the control group （4.00 ± 0.78 vs. 4.75 ± 0.68, t = - 2. 800, P = 0. 009）. Conclusion Performance of TUSLC with conventional devices is safe and feasible. Besides the advantages of no more operative costs and definite cosmetic results over TLC, this approach, based on abundant surgical experience, possesses potential minimal invasion.

关 键 词：腹腔镜胆囊切除术 单一部位腹腔镜手术 经脐腹腔镜手术 

分 类 号：R657.4[医药卫生—外科学]