摘要
目的探讨经脐三孔腹腔镜胆囊切除术（transumbilical laparoscopic cholecystectomy,TULC）的可行性。方法取脐下缘10 mm、脐右上缘3 mm及脐左上缘5 mm穿剌孔,分别置入Storz 10 mm30°腔镜及直线型刚性器械,超声刀或电凝钩进行组织分离,应用腔镜下结扎缝合技术处理胆囊管和（或）胆囊动脉。结果 160例行胆囊切除术,3例因胆囊炎症水肿严重、胆囊三角解剖困难行胆囊部分切除术。无中转常规腹腔镜手术或开腹手术。联合肝囊肿开窗术1例,联合胆囊十二指肠瘘修补术2例。手术时间20~250 min,平均65 min。术中无不可控制出血,术后无出血、胆漏、感染等并发症。141例随访1~15个月,平均10.6月。术后右上腹部轻微隐痛不适2例,复查B超无残余胆囊、胆囊窝积液及胆总管结石等发生;慢性腹泻1例,经饮食调节2个月后痊愈;其余病例均无明显自觉症状。结论经脐缘三点穿刺入路的TULC安全可行。
Objective To investigate the feasibility of transumbilical cholecystectomy with laparoscopy with three trocars.Methods Three trocars were placed at 10 mm below and 3 mm above the umbilicus,and 5 mm to the left upper edge of the umbilicus.Storz 10 mm 30° laparoscope and rigid instruments were used.Ultrasonic scalpel or electrocoagulation was employed to separate the tissues,and then the cystic duct and/or cystic artery were sutured under the laparoscope. Results Totally 160 patients received the operation;none of them were converted to conventional laparoscopy or open surgery.Partial cholecystectomy was carried out in three of the patients because of severe inflammation of the cyst.Hepatic cyst fenestration was carried out in 1 case,and cholecystocolonic fistulectomy was performed on two patients.The operation time in this series ranged from 20 to 250 minutes（the mean time for fenestration was 65 minutes）.No uncontrollable bleeding,bile leakage,or infections occurred in the patients.A follow-up for a mean of 10.6 months（1-15 months） were achieved in 141 patients,of which,two cases complained of mild right upper abdominal pain without showing residual cyst,gallbladder forssa effusion or bile duct stones by B-ultrasonography;one patient developed chronic diarrhea and was then cured by dietotherapy. Conlcusions Transumbilical laparoscopic cholecystectomy with three trocars is safe and feasible.
出处
《中国微创外科杂志》
CSCD
2011年第3期275-277,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
经脐入路
腹腔镜胆囊切除术
Transumbilical approach
Laparoscopic cholecystectomy
