经脐单套管三通道与经脐腹壁内三通道单孔腹腔镜胆囊切除术的对比研究

摘要

目的:探讨经脐腹壁内三通道单孔腹腔镜胆囊切除术( laparoscopic cholecystectomy,LC)的手术经验及临床价值.方法:回顾分析2010年6月至2011年12月为11例患者行经脐单孔腹腔镜胆囊切除术的临床资料.11例患者分别行经脐单套管三通道单孔腹腔镜胆囊切除术(对照组)及经脐腹壁内三通道单孔腹腔镜胆囊切除术(改良组).对比分析两组患者手术时间、手术并发症、术后24 h使用镇痛剂例数及术后住院时间等.结果:11例手术均获成功,无并发症发生,均于4d出院.两组患者术后住院时间及使用镇痛剂例数差异无统计学意义(P＞0.05).对照组手术时间95 ～ 145 min,平均(120.25±18.95) min;改良组手术时间40 ～ 70 min,平均(55.71±9.74) min;两组差异有统计学意义(P＜0.05).结论:经脐单套管三通道单孔腹腔镜胆囊切除术手术器械平行置入,前端狭小术野内腹腔镜、抓钳及主操作器械运动时相互干扰,难以相互配合,多顾此失彼,且易漏气,造成手术困难、时间延长.经脐腹壁内三通道单孔腹腔镜胆囊切除术器械间的距离相对增加,相互干扰减少,操作空间亦相对增加,腹壁组织相对柔软,操作较灵活、漏气少,安全可行.相对传统LC而言,单孔手术操作困难,对术者技术要求较高；但术后腹壁无明显可见疤痕,美容效果极佳,具有临床推广价值.%Objective: To explore the application of transumbilical single port laparoscopic cholecystectomy operation experience. Methods: In Jun. 2010 to Dec. 2011 were performed in 11 cases of transumbilical single port laparoscopic cholecystectomy clinical data into experience of single umbilical trocar puncture three channel single port laparoscopic cholecystectomy (control group) and transumbilical abdominal wall within the three channel single port laparoscopic cholecystectomy ( control group). the two groups were compared. Comparison of the two groups in operation time,operation complications, postoperative analgesic agent24h use cases and postoperative hospitalization time and so on. Results:Eleven cases were all successful operation,no complications occurred,were discharged 4 days. The two group at the time of postoperative hospitalization no statistical difference (P ＞ 0. 05). Experience of single umbilical trocar three channel group average operation time 95-145 min, (120. 25 ± 18. 95) was significantly higher than that of min, modified within the umbilical three channel single port laparoscopic cholecystectomy group operation time 40-70 min, (55.71 ±9.74) min average. The difference was statistically significant {P ＜0.05) ;the use of analgesic agents with no significant difference between the number of the same. Conclusions: The experience of single umbilical trocar puncture three channel single port laparoscopic cholecystectomy operation device is parallel to front, in narrow operative field, grasping forceps in endoscopic and main operation equipment movement will interfere with each other,it is difficult to cooperate with each other,often care for this and lose that,and is easy to leak,causing difficulties in operation time. Transumbilical abdominal wall within the three channel single port laparoscopic cholecystectomy makes e-quipment the distance between the relative increase, mutual interference reduction, operation space relative increase, abdominal wall tissue relatively soft operation more flexible leak less, safe and feasible. But compared with the traditional LC operating difficulties, with higher technical requirements for. Postoperative abdominal wall scar,beauty effect is good,worthy of popularization.