经脐单孔腹腔镜胆囊切除术与常规腹腔镜胆囊切除术的比较

摘要

Objective To explore the value of transumbilical single-port laparoscopic cholecystectomy ( TUSPLC ). Methods We retrospectively analyzed the clinical data of 115 patients with gallbladder polypus or stone without severe cholecystitis in our hospital from May 2010 to May 2011. The patients were divided into single-port (n =55) and routine groups (n =60). The operation time, intraoperative blood loss, postoperative analgesia, hospital stay and complications were compared between the two groups. Results In the single-port group, TUSPLC was completed in 52 cases, the other 3 cases were converted to routine LC because of severe adhesion of the Calot' s triangle (2 cases), or hyperplastic left liver lobe ( 1 case). In the routine group, the procedure was completed in all the cases. Single-port group showed significant longer operation time than the routine group, but similar intraoperative blood loss and postoperative hospital stay [ (52. 5 ± 21. 8) min vs. (43. 3 ± 17. 6) min, t = 2. 433, P = 0. 016; (19.5 ±9.5) ml vs. (22.2 ±8.0) ml, t = 1. 633, P =0.105; (2.5 ± 1.4) d vs, (2.3 ± 1.2) d, t = -0.814, P =0.417]. Two patients from single-port group received postoperative analgesia, while 12 patients in the routine group underwent the treatment (χ2 = 6.646, P=0.010). In both the groups, no patient developed hemorrhage, biliary leakage, or injury to the bile duct. 112 patients received an follow-up for 0. 5 - 11 months with a mean of 6. 2 months, during which no complications occurred. Conclusions Compared with routine LC, TUSPLC is safer with better cosmetic results and less postoperative pain. However, the procedure requires high surgical skills and refined equipments.%目的 探讨经脐单孔腹腔镜胆囊切除术(transumbilical single port laparoscopic cholecystectomy,TUSPLC)的价值. 方法 2010年5～ 2011年5月115例无严重胆囊炎症的胆囊息肉样病变或胆囊结石,分别施行TUSPLC(单孔组,n=55)和常规LC(常规组,n=60).比较2组手术时间、术中出血量、术后镇痛、术后住院时间及术后并发症. 结果 单孔组52例顺利完成TUSPLC,3例中转LC(2例因胆囊三角粘连致密,1例因左肝叶肥厚影响视野)；常规组均顺利完成手术.单孔组手术时间(52.5±21.8)min显著长于常规组(43.3±17.6)min(t =2.433,P=0.016)；单孔组术中出血量(19.5±9.5)ml与常规组(22.2±8.0)ml无统计学差异(t=1.633,P=0.105)；单孔组术后住院时间(2.5±1.4)d与常规组(2.3±1.2)d无统计学差异(t=-0.814,P=0.417)；单孔组2例术后需要镇痛,常规组12例,2组有显著性差异(x2=6.646,P=0.010)；2组术后均无出血、胆漏、胆管损伤等并发症发生.112例随0.5 ～11个月,平均6.2月,均无并发症发生. 结论 TUSPLC与常规LC相比安全、可行,具有瘢痕不明显且隐避,术后疼痛轻等优点,但对术者技术和设备要求较高.