Objective To describe our experience on transumbilical single-incision laparoscopic cholecystectomy ( SILC ) . Methods From May 2009 to August 2011, we performed transumbilical SILC on 500 patients in our hospital. Through an umbilical incision, one 10-mm trocar and two 5-mm trocars were placed in a reverse triangulation pattern. With ultrasonic scalpel, cholecystectomy was completed retrogradely via the posterior Calot' s triangle Results One patient was converted to three-port laparoscopy because of an accessory bile duct, and one' patients was converted to four-port procedure due to uncontrollable hemorrhage; in the other 498 cases, transumbilical SILC was completed successfully within a mean of (51. 4 ± 20. 1) min. the intraoperative blood loss ranged from 5 to 100 ml (medium, 10 ml). After the operation, the gastrointestinal function recovered in (2.0 ±0.8) days. One patient developed capillary bile duct leak and was then cured by conservative therapy. One patient showed postoperative hemorrhage at the liver bed, and thus received a second operation, and recovered afterwards. The patients were followed up for 1 to 3 months, during which except for subcutaneous hematoma at the incision in two patients, no other complications occurred; all the patients recovered well. Conclusions Transumbilical SILC is safe and effective. It shall be widely sued for its minimal invasion and good cosmetic outcomes. Strict surgical indications are the key to the procedure.%目的 总结经脐单切口腹腔镜胆囊切除术(single-incision laparoscopic cholecystectomy,SILC)的临床经验.方法2009年5月～2011年8月行SILC 500例.术中经脐部切口置入1枚10 mm trocar及2枚5 mm trocar,3枚trocar呈倒三角形方式排列.利用超声刀经胆囊后三角入路逆行切除胆囊. 结果 1例因术中发现存在副肝管中转为四孔法,1例因术中出血不易控制中转三孔法,其余SILC手术均获成功,手术时间(51.4±20.1) min.术中出血量中位数10 ml(5 ～ 100 ml),胃肠蠕动功能恢复时间(2.0±0.8)d.1例术后出现毛细胆管胆汁漏,经保守治疗痊愈；1例术后出现肝床渗血,二次手术治愈.随访1～3个月,发生并发症的2例痊愈,无其他并发症发生；2例切口处皮下血肿,经保守治疗后愈合,其余患者无出血、胆漏、切口疝等并发症发生,术后恢复良好,手术瘢痕隐蔽. 结论 SILC安全有效,且具有创伤小、美容效果好等优点.在严格选择病例、掌握适应证及操作原则后,可逐渐学习并掌握,便于广泛开展.
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