新型经脐入路腹腔镜胆囊切除术.docVIP

新型经脐入路腹腔镜胆囊切除术【摘要】? 目的：探讨经脐双套管腹腔镜胆囊切除术的可行性，并与经脐单套管三通道腹腔镜胆囊切除术进行比较。方法：根据手术方法，将患者分成经脐单套管三通道腹腔镜胆囊切除组（ 12例 ）和经脐双套管腹腔镜胆囊切除组（ 17例），比较两组在手术时间、手术并发症、术后24h使用镇痛剂例数及术后住院时间等情况。结果：29例手术全部成功，无并发症发生。经脐单套管三通道组手术时间90～150min，平均(120.25±18.97）min,明显高于经脐双套管组手术时间20～50min，平均(35.71±9.74）min，差异有统计学意义(P 0.05)；经脐单套管三通道组术后24h使用镇痛剂例数显著高于经脐双套管组（P 0.05）；两组在术后住院时间上无统计学差异（P 0.05 ）。结论：与经脐单套管三通道组相比，经脐双套管技术在腹腔镜胆囊切除术的临床应用中更具实用性。 【关键词】? 胆囊切除术，腹腔镜；脐 ???????? 【Abstract】? Ｏbjective:To evaluate the feasibility of transumbilical double trocars laparoscopic cholecystectomy(DTLC)by comparing with the transumbilical triplechannel trocar laparoscopic cholecystectomy(TCTLC).Methods:29 patients with? chronic gallbladder disease were divided into two groups according to the approach taken for them: transumbilical double Trocar laparoscopic cholecystectomy(DTLC)(12 cases)and transumbilical? triplechannel trocar laparoscopic cholecystectomy(TCTLC)(17 cases).Operation time,postoperative hospital stay,postoperative pain between the two groups were compared.Results: The operative time for TCTLC was 90150min,the average (120.25±18.97)min,which was significantly longer than that for DTLC which was 2050min,the average (35.71±9.74)min,(P 0.001),and the number of cases using analgesics in TCTLC was more than that in DTLC(P 0.05). There was no significant difference （P 0.05）between the two groups in postoperative hospital stay.Conclusions:Compared with the approach of transumbilical triplechannel cholecystectomy，the transumbilical doubleport cholecystectomy is a more feasible and practical approach. ??? 【Key words】? Cholecystectomy，laparoscopy;Umbilical ??? 经自然腔道手术具有术后腹壁无疤痕的优点，近来已成为微创外科关注的热点。但经自然腔道手术实际应用的技术难度较高，并存在腹腔感染和脏器误穿的风险［1,2］。单套管三通道经脐入路手术（transumbilical endoscopic surgery,TUES）虽然在技术上更加简单、安全和可行［3,4］，但应用于胆囊切除的技术难度还是比较大,手术时间较长。最近我们将三孔迷你腹腔镜胆囊切除术［5］的技术进行了改进，设计了经脐双套管腹腔镜胆囊切除(transumbilical laparoscopic cholecystectomy with two trocars,TULCWTT)，临床应用17例，效果良好。本文介绍了这种新的手术方法，并与单套管三通道腹腔镜胆囊切除术进行了比较。 ??? 1? 资料与方法 ??? 1.1