徐伟宏 梅锋 余汉辉

【摘要】 目的 探討改良经脐单孔腹腔镜胆囊切除术（TUSPLC）在治疗胆囊良性疾病中的临床效果。方法 40例胆囊良性疾病患者， 均行改良经脐单孔腹腔镜胆囊切除术， 观察患者的术中出血量、手术时间、术后肛门排气时间、术后镇痛药使用率、术后住院时间。结果 本组40例患者中除1例因胆囊坏疽改为常规四孔法腹腔镜胆囊切除完成手术， 其余患者均顺利完成经脐单孔腹腔镜胆囊切除术， 手术时间35～125 min， 平均手术时间（74±17）min。术中出血量3～75 ml， 平均术中出血量（15±21）ml， 术后均未出现大出血。术后住院时间2～6 d， 平均住院时间（3.5±0.9）d， 术后肛门排气时间8～32 h， 平均排气时间（11.5±6.9）h， 术后镇痛药使用率7.7%（3/39）。急性胆囊炎术后若炎症水肿严重需经脐轮切口放置腹腔引流管引流， 术后24 h腹腔引流量25～105 ml， 平均腹腔引流量（55±17）ml， 术后1～3 d拔除腹腔引流管。所有患者术后随访3～12个月无不适。结论 经脐单孔腹腔镜胆囊切除术治疗胆囊良性疾病安全、临床效果好， 值得临床推广应用， 尤其是基层医院更适合开展。

【关键词】 胆囊良性疾病;腹腔镜;胆囊切除术;单孔;临床效果

DOI：10.14163/j.cnki.11-5547/r.2020.20.004

【Abstract】 Objective   To discuss the clinical effect of improved transumbilical single-port laparoscopic cholecystectomy （TUSPLC） for benign gallbladder diseases. Methods   A total of 40 patients with benign gallbladder diseases all underwent improved transumbilical single-port laparoscopic cholecystectomy， and the amount of intraoperative hemorrhage， operation time， postoperative anal exhaust time， postoperative analgesic drug use rate， postoperative hospitalization time were observed. Results   In 40 patients， except one patient with gallbladder stones and acute gangrenous cholecystitis who underwent laparoscopic cholecystectomy by four-port method， all the other patients were successfully operated by improved transumbilical single-port laparoscopic cholecystectomy. The operation time was 35-125 min， with an average of （74±17） min. The amount of intraoperative hemorrhage was 3-75 ml， with an average of （15±21） ml， and no massive hemorrhage occurred postoperatively. The postoperative hospitalization time was 2-6 d， with an average of （3.5±0.9） d， the postoperative anal exhaust time was 8-32 h， with an average of （11.5±6.9） h， the postoperative analgesic drug use rate was 7.7%（3/39）. If the inflammation and edema were serious after the operation of acute cholecystitis， the abdominal drainage tube should be placed through the umbilical incision for drainage. 24 h after the operation， the average abdominal drainage flow was 25-105 ml， the average abdominal drainage flow was （55±17） ml， and the abdominal drainage tube should be removed 1-3 d after the operation. No discomfort in all patients during 3-12 months of follow-up. Conclusion   Transumbilical single-port laparoscopic cholecystectomy is safe and effective in the treatment of benign gallbladder diseases. It is worthy of clinical popularization and application， especially in primary hospitals.

【Key words】 Benign gallbladder diseases; Laparoscopic; Cholecystectomy; Single-port; Clinical effect

胆囊良性疾病中以胆囊结石、胆囊息肉多见， 部分胆囊结石、胆囊息肉需进行手术治疗， 腹腔镜胆囊切除术早已成为手术治疗胆囊良性疾病的金标准术式[1]。

随着腹腔镜技术的不断发展， 进一步减小了手术创伤， 获得了更好腹壁美容效果， 加快了患者术后康复， 近年来又研究出了经脐单孔腹腔镜胆囊切除术[2]。本院2017年3月～2019年3月对40例胆囊良性疾病需手术治疗的患者实施改良经脐单孔腹腔镜胆囊切除术， 取得了较好的临床效果， 现报告如下。……