摘要
目的：对比分析免气腹悬吊式经脐单孔腹腔镜胆囊切除术（gasless laparoendoscopic single—site cholecystectomy，GLESC）和传统腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）的优缺点。方法：2009年6月至2010年7月为34例患者行GLESC，为35例患者行传统LC。观察两组患者的体重指数（BMI）、合并症、手术时间、出血量、中转开腹率、c反应蛋白（C—reactiveprotein，CRP）水平、疼痛指数、肩背部疼痛发生率、恢复进食时间、术后住院时间及切口并发症等。结果：GLESC组2例患者因BMI过高显露欠佳，改行悬吊合并低气腹单孔腹腔镜手术，32例成功施行GLESC，35例成功实施LC。术后随访48～174d，平均120d。平均手术时间GLESC组[（78．91±24．59）min]长于LC组[（46．844±9．60）min]（P〈0．05）。两组术后6h疼痛指数相似[GLESC组为（4．964±0．98），LC组为（5．42±1．17）l。术后24h疼痛指数GLESC组（3．39±1．12）明显低于LC组（4．84±1．42）（P=0．001）。GLESC组肩背部疼痛发生率低于LC组（P=0．009）。两组术中出血量、CRP水平、住院时间均相似，差异无统计学意义。两组均无切口并发症发生。结论：对大多数胆囊疾病患者而言，GLESC是安全、有效、可行的，具有优于传统腹腔镜手术的美容效果及术后疼痛轻、康复快等优点。对于一定BMI和身高的患者，术野显露满意，手术入路简单有效。GLESC可在将来成为标准的、可普遍施行的手术。
Objective：On the request to make laparoscopic surgery even more minimally invasive,laparoscopic single-site surgeries have been described. A novel technique of gasless laparoendoscopic single-site surgery with abdominal wall lift （AWL） was presented for cholecystectomy. This study aimed to compare the outcome and morbidity parameters of gasless laparoendoscopic single-site cholecystectomy（GLESC） and standard laparoscopic cholecystectomy （LC）. Methods：Data from 34 patients who underwent GLESC and 35 patients who underwent LC between Jun. 2009 and Jul. 2010 were collected. The BMI, associated disease,operating time, estimated blood loss （EBL） ,rate for conversion to open procedure, the C-reactive protein （CRP） level,pain scores at 6h and 24h,shoulder and back pain rate,time taken for resumption of oral intake, postoperative hospital stay, wound complications were noted and a retro- spective analysis was conducted. Results：Two cases in the GLESC group were converted to laparoendoscopic single-site cholecystectomy using AWL combined with low-pressure pneumoperitoneum because of high BMI and poor exposure. 32 underwent GLESC and 35 underwent LC. The follow-up period was 48 to 174d （mean, 120d）. The mean operating time was longer in the GLESC group[（78.91 ± 24.59） mini than in the LC group [ （46.84 ± 9.60） min] （ P 〈 0.05 ）. The mean pain scores at 6h were similar in the two groups [ （4.96 ± 0.98 ）for the CLESC group vs. （5.42± 1.17 ） for the LC group;nonsignificant difference） ]. However the pain scores at 24h were significantly lower in the GLESC group （3.39 ± 1.12） than in the LC group（4.84 ± 1.42） （P =0. 001 ）. The shoulder and back pain rate of GLESC group was significantly lower than that of LC group （P =0. 009）. The EBL,the CRP level and the hospital stay were similar in the two groups, respectively. There were no wound complications such as wound infection or hernia. Conclusions：The GLESC with AWL is safe, effective and feasible in most cases of gallbladder diseases. It appears to be cosmetically superior compared to standard LC and other advantages include less postoperative pain and faster postoperative recovery. The techniques provide satisfactory exposure of operative field and an easier access method for patients having certain BMI and height. It can be potentially recommended as a standard and reproducible procedure.
出处
《腹腔镜外科杂志》
2011年第2期95-99,共5页
Journal of Laparoscopic Surgery
关键词
胆囊切除术
腹腔镜
经脐
单孔
免气腹
Cholecystectomy, laparoscopic
Transumbilicus
Single-port
Gasless
