摘要
目的比较不同器械经脐单切口与三孔腹腔镜胆囊切除术的安全性、手术效果。方法选取2011年9月～2012年6月胆囊切除术150例，随机分为3组：A组行经脐单切口腹腔镜胆囊切除术（可转腕器械）；B组行经脐单切口腹腔镜胆囊切除术（普通器械）；C组行三孔腹腔镜胆囊切除术。比较手术时间、术中出血量、术后疼痛、满意程度、C反应蛋白、免疫球蛋白及T淋巴细胞亚群等损伤指标。结果中位手术时间A组40min和B组37．5min显著长于C组25min（X2=25．165，P=0．000；X2=16．184，P=0．000），但A、B2组无统计学差异（X2=0．987，P=0．610）。中位术中出血量A组10．0ml和B组10．0ml显著多于C组7．5ml（X2=12．571，P=0．002；X2=13．619，P=0．001），但A、B2组无统计学差异（X2=0．021，P=0．989）。3组术后疼痛评分、满意程度、创伤及对免疫系统影响均无差异（P〉0，05）。发生并发症4例，其中胆漏3例（B组1例，C组2例），术中胆道损伤l例（B组），A组未发生并发症。结论SILC是一种兼顾安全与美观的胆囊切除术式，可转腕器械使SILC更具安全性。
Objective To compare the safety and the clinical effect of single-incision laparoscopie choleeystectomy （SILC） and three-port laparoscopie cholecysteetomy （TLC）. Methods A total of 150 patients undergoing [aparoscopie cholecystectomy from September2011 to June 2012 were randomly divided into three groups with 50 patients in each group （group A： SILC with an adjustable and rotatable laparoscopic instrument; group B： S1LC with common laparoscopic instrument; group C： TLC）. Operative time, intraoperative blood loss, postoperative pain, patient satisfaction scores, C-reactive protein, immune globulin （IgG, IgA, IgM） and T-lymphocyte subsets （ CD3＋ , CD4 ＋ , CD8＋ ） were compared among the three groups. Results The median operative time of Group A （40 min） and Group B （37.5 min） were longer than that of Group C （25 min） （X2 = 25. 165, P =0. 000; X2 = 16. 184, P = 0. 000）and no significant difference between Group A and B was found （X2 = 0. 987, P = 0. 610）. The median blood loss of Group A （10.0 ml） and Group B （10.0 ml） were more than that of Group C （7.5 ml） （X2 =12.571, P=0.002;X2 =13.619, P=0.001）, and no significant difference between Group A and B was found （X2 = 0. 021 ,P = 0. 989 ）. Postoperative pain scores, satisfaction scores and the immunological indicators were not significantly different among the three groups （ P 〉 0.05 ）. Complications occurred in 4 eases including one case of bile injury （group B） and three cases of bile leakage （ 1 case in group B and 2 eases in group C） , while no complication was found in group A. Conclusions SILC is safe and feasible, with good cosmetic effect. SILC with the adjustable and rotatable instrument improves the safety of the procedure.
出处
《中国微创外科杂志》
CSCD
2014年第1期38-42,共5页
Chinese Journal of Minimally Invasive Surgery
基金
卫生部资助课题
项目编号:W2012RQ06
关键词
单切口
腹腔镜器械
可转腕器械
前瞻性随机对照研究
腹腔镜胆囊切除术
Single-incision
Laparoscopic instrument
Adjustable and rotatable instrument
Prospective randomized controlled trial
Laparoscopic cholecystectomy
