经脐括弧样入路隐疤腹腔镜胆囊切除术安全性和疗效  

Safety and efficacy of scar-hidden laparoscopic cholecystectomy via umbilical bracket-like approach

作　　者：陈阳 李东[2] 樊友文 黄飞[2] 陶强[2] 唐亚军[2] 邓量 汤地[2] Chen Yang;Li Dong;Fan Youwen;Huang Fei;Tao Qiang;Tang Yajun;Deng Liang;Tang Di(Department of Gastrointestinal Hepatobiliary Surgery,Shenzhen Longhua District Central Hospital,Shenzhen 518000,China;Department of General Surgery,the Seventh Affiliated Hospital of Sun Yat-sen University,Shenzhen 518107,China)

机构地区：[1]深圳市龙华区中心医院胃肠肝胆外科,518000 [2]中山大学附属第七医院普通外科,深圳518107

出　　处：《中华肝脏外科手术学电子杂志》2021年第1期68-71,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：深圳市卫生计生系统科研项目(SZFZ2018001)。

摘　　要：目的探讨常规器械经脐两侧括弧样入路隐疤腹腔镜胆囊切除术(LC)的安全性和疗效。方法回顾性分析2019年6月至2019年10月在中山大学附属第七医院行LC的10例患者临床资料。其中男3例,女7例;年龄27~55岁,中位年龄42岁。患者均签署知情同意书,符合医学伦理学规定。经脐两侧行括弧样切口置入10 mm Trocar,分别置入操作和观察器械,并于右肋缘下穿刺Minilap针,联合采用荷包针将胆囊底缝吊于右上季肋部加强暴露,完成LC。观察手术及并发症情况。结果所有患者成功完成手术,无中转开腹。脐左侧观察、脐右侧操作孔的Trocar布局可明显减小单孔LC的“筷子效应”。Minilap+缝线提吊法有利于术野充分暴露和提供足够的张力。手术时间中位数45(30~75)min,术中出血量5(3~20)ml。患者术后疼痛评分1(0~2)分。术后住院时间2(1~3)d,无手术相关并发症发生。术后2周复查脐部括弧样切口愈合好、瘢痕隐匿,患者满意度100%。结论与既往的单孔LC相比,应用常规器械经脐两侧括弧样入路隐疤LC具有微创、美观、便利、经济的优点,适用于大多数胆囊良性疾病的外科治疗。Objective To evaluate the safety and efficacy of scar-hidden laparoscopic cholecystectomy(LC)via umbilical bracket-like approach using conventional instruments.Methods Clinical data of 10 patients undergoing LC in the Seventh Affiliated Hospital of Sun Yat-sen University from June to October 2019 were retrospectively analyzed.Among them,3 patients were male and 7 female,aged from 27 to 55 years with a median of 42 years.The informed consents of all patients were obtained and the local ethical committee approval was received.A 10-mm Trocar was inserted through a bracket-like incision of both sides of umbilical.The operation and observation instruments were inserted.A Minilap needle was inserted under the right costal margin,and the gallbladder bottom was sutured to the right superior costal region using pursestring suture to enlarge the exposure.LC were completed.The surgical status and postoperative complications were observed.Results All patients completed LC successfully.No patient was converted to open surgery.The left observation port and the right operation port significantly reduced the"chopstick effect"of single incision LC.Minilap+suture lifting technique could fully expose the surgical field and provide sufficient tension.The median operation time was 45(30-75)min.Intraoperative blood loss was 5(3-20)ml.The postoperative pain score was 1(0-2).The length of postoperative hospital stay was 2(1-3)d.No LC-induced complications occurred.Reexamination at postoperative 2 weeks found that the umbilical bracket-like incision healed well and the scar was invisible.The satisfaction rate of patients was 100%.Conclusions Compared with the conventional single-port LC,scar-hidden LC via umbilical bracket-like approach using conventional instruments has advantages such as micro invasiveness,better appearance,better convenience and lower cost,which is applicable for treating most benign gallbladder diseases.

关 键 词：胆囊切除术 腹腔镜 单孔 治疗结果 

分 类 号：R657.4[医药卫生—外科学]