针式组合式器械胆囊底悬吊两孔法腹腔镜胆囊切除术的技术改进及疗效分析  

Technical modification and the effect of two-port laparoscopic cholecystectomy by fundus suspension with needle assembly instruments

作　　者：刘峰 田明国[1] 范雄伟 冯广平 麦吉元 霍文杰 田士林 苏伟 辛国军[1] 虎晓军 张晓燕 LIU Feng;TIAN Mingguo;FAN Xiongwei;FENG Guangping;MAI Jiyuan;HUO Wenjie;TIAN Shilin;SU Wei;XIN Guojun;HU Xiaojun;ZHANG Xiaoyan(Department of Hepatobiliary Surgery,the People’s Hospital of Ningxia Hui Autonomous Region,Yinchuan,Ningxia 750002,China;Department of General Surgery,the People’s Hospital of Wuhai,Wuhai,Inner Mongolia 016099,China;Department of General Surgery,the People’s Hospital of Wuzhong,Wuzhong,Ningxia 751199,China;Department of General Surgery,the People’s Hospital of Haiyuan County,Zhongwei,Ningxia 755299,China;Department of General Surgery,the People’s Hospital of Zhongwei,Zhongwei,Ningxia 751799,China)

机构地区：[1]宁夏回族自治区人民医院肝胆外科,宁夏银川750002 [2]乌海市人民医院普通外科,内蒙古乌海016099 [3]吴忠市人民医院普通外科,宁夏吴忠751199 [4]海原县人民医院普通外科,宁夏中卫755299 [5]中卫市人民医院普通外科,宁夏中卫755099

出　　处：《肝胆胰外科杂志》2024年第10期612-616,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：宁夏回族自治区重大科技成果转化项目(2023CJE09035)。

摘　　要：目的探讨腹腔镜胆囊切除术(LC)的实用减孔技术及其临床效果。方法回顾性分析2010年7月至2023年12月在宁夏回族自治区人民医院、内蒙古乌海市人民医院、宁夏吴忠市人民医院、宁夏海原县人民医院和宁夏中卫市人民医院共计1120例接受针式组合式器械胆囊底悬吊两孔法LC的患者的临床资料。经脐切口采用细头穿刺器、经剑突下微切口采用3mm穿刺器以及对胆囊动脉及胆囊管采用线扎法,分析该技术改进的临床效果。结果1120例患者中,慢性结石性胆囊炎816例,胆囊息肉82例,急性结石性胆囊炎222例。全部采用针式组合式器械悬吊胆囊底部,经脐孔上缘下方弧形切口分别插入10 mm镜鞘和5 mm操作鞘或在镜鞘旁直接插入无损伤钳;其中剑突下采用5 mm穿刺鞘890例,采用3 mm穿刺鞘230例;胆囊管和胆囊动脉的处理采用5 mm Hem-o-lok夹715例,采用丝线结扎405例。1120例中需要在右锁骨中线肋缘下增加5mm穿刺孔68例,增孔率6.07%,其中在右腋前线肋缘下再增加5mm穿刺孔21例;该68例中,因胆囊炎症重或感染胆汁外溢或胆囊大部切除需要腹腔引流而增孔者51例,因胆囊周围致密粘连或操作出血不易控制而增孔者17例。无中转开腹病例;平均手术时间(41.5±18.8)min,其中胆囊底针式器械悬吊操作时间(3.8±2.4)min;平均出血量(10.5±5.8)mL;无胆漏、胆管损伤及术后严重出血并发症。结论针式组合式器械胆囊底悬吊两孔法LC具有显露充分及操作简便的优点,可顺利完成打结技术及采用3mm器械的操作。Objective To explore a simple and practical method for reducing the incision in laparoscopic cholecystectomy(LC)and its clinical effect.Methods A retrospective analysis was conducted on the clinical data of 1120 cases,who undergone two-port LC by fundus suspension with needle assembly instruments in the People’s Hospital of Ningxia Hui Autonomous Region,the People’s Hospital of Wuhai,the People’s Hospital of Wuzhong,the People’s Hospital of Haiyuan Country and the People’s Hospital of Zhongwei from Jul.2010 to Dec.2023.The method includes a fine head trocar in the umbilical incision,a 3 mm trocar in a mini-incision under the xiphoid process,and thread ligation for the cholecystic artery and the duct.The technical improvements and clinical effects were analyzed.Results Among the 1120 patients,there were 816 cases of chronic calculous cholecystitis,82 cases of gallbladder polyps,and 222 cases of acute calculous cholecystitis.All patients were exposed by a set of assembly needle instruments of the gallbladder fundus,and through an arc-shaped incision below the upper edge of the umbilicus,inserted in a 10 mm endoscope Trocar and a 5 mm operation Trocar or directly inserted a forcep;890 cases were treated with a 5 mm Trocar under the xiphoid process,and 230 cases were treated with a 3 mm Trocar;715 cases of cystic duct and cystic artery were clamped with 5 mm Hem-o-lok,and 405 cases were ligated with silk thread.Among the 1120 cases,68 cases needed adding a 5 mm Trocar at the right middle clavicle line subcostly,with an increased incision rate 6.07%;in whom,21 cases needed another 5 mm Trocar at the right anterior axillary line subcostly.Among 68 cases needed adding a 5 mm Trocar,51 cases required abdominal drainage due to severe cholecystitis or infected bile leakage or partial cholecystectomy,and 17 cases were due to dense adhesions around the gallbladder or difficulty in controlling surgical bleeding.No case was converted to open surgery.The mean operative time was(41.5±18.8)min,with a gallbladder fundus

关 键 词：腹腔镜胆囊切除术 胆囊底悬吊 针式组合式器械 两孔法 技术改进 

分 类 号：R657.4[医药卫生—外科学]