经脐入路腹腔镜胆囊切除术40例临床分析.docVIP

经脐入路腹腔镜胆囊切除术40例临床分析 肖怀文 朱江帆 吴鸣 龚建民 孔祥东 [摘要] 目的：探讨经脐入路内镜手术（Transumbilical endoscopic surgery TUES）用于胆囊切除术的安全性、可行性及手术特点。方法：回顾分析2010年～2012年作者收治的40例TUES胆囊切除术患者的临床资料：均采用脐下20mm切口，造气腹后穿刺入3只穿刺鞘（Trocar）,中间10mm，两边各插入一只5mm，术中使用10mm镜管，曲线型抓钳、电勾，超声刀及5mm Hemolock施夹器等。结果：40例均获得成功，无中转或增加穿刺孔；手术时间（65.75±24.80）min；术中出血（29.13±19.84）ml；不放置引流，无术后并发症发生。随访3月～3年，无术后胆漏、迟发性胆漏，黄疸，切口感染等发生，腹壁无可见瘢痕。结论：手术操作要求较高，但超声刀及曲线型抓钳的使用使TUES胆囊切除术安全可行，术后腹壁无瘢痕，美观，值得推广。 [关键词] 经脐手术 腹腔镜胆囊切除术 无瘢痕 Transumbilical Endoscopic Surgery in Laparoscopic Cholecystectomy: Report of 40 Cases XIAO Huai-wen, ZHU Jiang-fan*, WU Ming, GONG Jian-ming, KONG Xiang-dong *Dongfang Hospital, TongJi Univercity ,Shanghai, 200120, China [Abstract] Objective: To investigate the safety, clinical characteristics and feasibility of laparoscopic cholecystectomy through TUES. Methods: From 2010 to 2012, the clinical data of 40 patients who have underwent transunbilical endoscopic laparoscopic cholecystectomy through three Trocars placed around umbilicus with only one incision were retrospectively analyzed at our hospital; All use below hilum and 20mm incision, made after pneumoperitoneum Pierce through three puncture sheath (Trocar), intermediate 10 mm, both sides each insert a 5 mm, intraoperative use 10 mm lens tube, curve type grab forceps, electricity hook, ultrasonic knife and 5 mm hemolock device, etc. Results: All cases were successfully , no transference or adding the puncture hole; The operation time is (65.75 ± 24.80 )min; The intraoperative bleeding is (29.13 ± 19.84 )ml; There are no drainage and postoperative complications. On 3 months to 3 years following-up, no postoperative bile leakage, late-occurred bile leakage, jaundice, incision infection occurs and no ?visible scar were found on the abdominal wall. Conclusions: The operation demanding is high , but the use of ultrasonic knife and curve type grab clamp to TUES cholecystectomy, it is safe and feasible. And the postoperative abdominal wall has no visible scar, looks beauti