经脐单孔腹腔镜胆囊切除术的技术改进与手术技巧

摘要

目的:探讨经脐单孔腹腔镜胆囊切除术的手术改进及技巧.方法:回顾分析2015年10月至2017年11月为257例患者行经脐单孔腹腔镜胆囊切除术的临床资料,其中胆囊结石242例,胆囊息肉15例.结果:246例成功完成单孔腹腔镜手术,成功率95.7%;11例因胆囊三角暴露不清改为两孔法腹腔镜胆囊切除术,无一例中转开腹.手术时间15～150 min,平均(50.3±21.5) min;术中出血量1～50 ml,平均(7.4±4.4) ml.术后切口渗血3例,皮下气肿2例,继发性胆总管结石1例,无腹腔内出血、胆管损伤、胆漏等早期严重并发症及胆道狭窄、脐疝等远期并发症发生.术后随访1～24个月,脐部切口疤痕隐蔽,美容效果好.结论:改进经脐单孔腹腔镜胆囊切除术后,在掌握一定手术技巧的基础上施术,技术难点容易突破,可安全、可靠地完成手术.%Objective:To explore the improvement and surgical skills of transumbilical single－port laparoscopic cholecystecto－my.Methods:The clinical data of 257 patients who underwent transumbilical single－port laparoscopic cholecystectomy from Oct.2015 to Nov.2017 were retrospectively analyzed.Among these patients,242 cases were gallbladder calculi and 15 were gallbladder polyp.Re－sults:Of all the 257 patients,246 patients (95.7%) were successfully conducted transumbilical single－port laparoscopic cholecystecto－my while the other 11 patients (4.3%) were converted to double－port laparoscopic cholecystectomy for the unclear Calot triangle with－out conversion to laparotomy.The duration of operation was from 15 min to 150 min with the average of (50.3±21.5) min.The intraop－erative blood loss was 1 ml to 50 ml with the mean of (7.4±4.4) ml.Three cases of postoperative incision bleeding ,2 cases of subcuta－neous emphysema and 1 case of secondary choledocholithiasis were found.Short－term severe postoperative complications such as intrap－eritoneal hemorrhage ,bile duct injury or bile leakage were not found.There were no long－term complications such as biliary strictures or umbilical hernia.The umbilical incisions were hidden well with almost invisible scar during the follow up of 1 to 24 months.Conclu－sions:With the improvement of transumbilical single－port laparoscopic cholecystectomy ,it is safe and reliable to conduct this operation on the basis of mastering certain surgical skills.