经脐无辅助单孔腹腔镜胆囊切除术(1)
摘要：目的 探讨经脐无辅助单孔腹腔镜胆囊切除术的优越性。方法 回顾性分析武汉市东西湖区人民医院2011年5月～2014年10月完成的27例经脐单孔腹腔镜胆囊切除(transumbilical single-port laparoscopic cholecystectomy，TUSPLC)患者的临床资料。手术方式为于脐上缘或脐下缘切开皮肤及皮下组织约20 mm长弧型切口，保持深部筋膜完整，建气腹成功后，于切口正中置入10 mm trocar，于两侧置入5 mm防漏气塑胶软管或trocar，利用单孔器械、弧形电钩或超声刀切除胆囊。结果 手术均获成功，手术时间45～120 min，无出血、胆漏、胆管损伤等并发症。结论 经脐部无辅助单孔腹腔镜胆囊切除术是安全的、可行的。
关键词：经脐；单孔；腹腔镜胆囊切除术
The Umbilical without Auxiliary Single-Arch Laparoscopic Cholecystectomy
, 百拇医药
CAI Lie
(Department of General Surgery，Dongxihu District People's Hospital，Wuhan 430040，Hubei，China)
Abstract：Objective To explore theumbilicus without auxiliary laparoscopic cholecystectomy through a transumbilical single incision. Methods The clinical data of 27 cases with single-arch laparoscopic cholecystectomy who were completed to the WuHan Dongxihu district people's hospital from May 2011 to October 2014 were retrospectively analyzed.operation method were that the skin and subcutaneous tissue around of umbilical edge or on the lower edga were cuted about 20mm long arc incision，keep the deep fascia intact，after pneumoperitoneum were built successfully，10mm trocar was piacemented on the center of the incision， 5mm plastic hose of prevented gas leakage or trocar was placemented on both sides，using single apparatus、electric arc hook or ultrasonic knife to remove the gallbladder.Results All surgery were successful，the operation was 45min～120min，no complications such as bleeding，bile leakage.Conclusion By the time without auxiliary single-arch laparoscopic cholecystectomy is safe and feasible.
, 百拇医药
Key words：Transumbilicus；Single-incision； Laparoscopic cholecystectomy
腹腔鏡胆囊切除术(Laparoscopic cholecystectomy，LC)由于具有创伤小、恢复快、并发症发生率低等优点，已经取代传统开腹手术，成为治疗良性胆囊疾病的“金标准”[1]。我院2011年5月～2014年10月完成的27例经脐无辅助单孔腹腔镜胆囊切除手术，现报告如下：
1 资料与方法
1.1一般资料 本组患者27例，男9例，女18例，年龄21～43岁，平均年龄(35±2)岁。其中胆囊结石21例，胆囊息肉6例，全组患者均经B超、CT或MRI确诊。
1.2手术器械 storz 5mm 30°和10 mm 30°腹腔镜各一个，10 mm trocar一个，5 mm无气阀的塑胶软管2个，5 mm弧形电钩、弧形分离钳、直形抓钳各一把，柳叶刀可弯曲单孔器械。其余与常规腹腔镜器械相同。
, 百拇医药
1.3切口设置 经脐部做弧形切口约20 mm，切开皮肤和皮下组织，保持深部筋膜完整，于切口正中置入10 mm trocar，于两侧置入5 mm塑胶软管，10 mm trocar为观察孔，左侧缘5 mm塑胶软管为主操作孔，右侧缘5 mm塑胶软管为辅助操作孔，三孔不相通，三者之间呈三角形。
1.4方法 术前准备和麻醉方法同常规腹腔镜胆囊切除术。患者取头高脚低30°、左侧倾斜15°，传统体位或两腿分开皆可，术者立于患者左侧，将胆囊壶腹向左上方拉起，以电凝钩胆囊管处浆膜，胆囊三角前、后腹膜，用弧形分离钳分离出胆囊管，确认胆囊管、胆总管和肝总管三管关系无误后，距胆总管0.5 cm处用hem-o-lok夹夹闭胆囊管，远端再用hem-o-lok夹夹闭胆囊管，于两夹之间剪断胆囊管。再分离出胆囊动脉，用hem-o-lok夹夹闭后切断或直接用超声刀切断。向左上方推起胆囊管远端，自胆囊床逐步分离胆囊。
2 结果
手术均获成功，无中转开腹病例。手术时间45～120 min，无出血、胆漏、胆管损伤等并发症，术后2～3 d出院。, 百拇医药(蔡烈)
关键词：经脐；单孔；腹腔镜胆囊切除术
The Umbilical without Auxiliary Single-Arch Laparoscopic Cholecystectomy
, 百拇医药
CAI Lie
(Department of General Surgery，Dongxihu District People's Hospital，Wuhan 430040，Hubei，China)
Abstract：Objective To explore theumbilicus without auxiliary laparoscopic cholecystectomy through a transumbilical single incision. Methods The clinical data of 27 cases with single-arch laparoscopic cholecystectomy who were completed to the WuHan Dongxihu district people's hospital from May 2011 to October 2014 were retrospectively analyzed.operation method were that the skin and subcutaneous tissue around of umbilical edge or on the lower edga were cuted about 20mm long arc incision，keep the deep fascia intact，after pneumoperitoneum were built successfully，10mm trocar was piacemented on the center of the incision， 5mm plastic hose of prevented gas leakage or trocar was placemented on both sides，using single apparatus、electric arc hook or ultrasonic knife to remove the gallbladder.Results All surgery were successful，the operation was 45min～120min，no complications such as bleeding，bile leakage.Conclusion By the time without auxiliary single-arch laparoscopic cholecystectomy is safe and feasible.
, 百拇医药
Key words：Transumbilicus；Single-incision； Laparoscopic cholecystectomy
腹腔鏡胆囊切除术(Laparoscopic cholecystectomy，LC)由于具有创伤小、恢复快、并发症发生率低等优点，已经取代传统开腹手术，成为治疗良性胆囊疾病的“金标准”[1]。我院2011年5月～2014年10月完成的27例经脐无辅助单孔腹腔镜胆囊切除手术，现报告如下：
1 资料与方法
1.1一般资料 本组患者27例，男9例，女18例，年龄21～43岁，平均年龄(35±2)岁。其中胆囊结石21例，胆囊息肉6例，全组患者均经B超、CT或MRI确诊。
1.2手术器械 storz 5mm 30°和10 mm 30°腹腔镜各一个，10 mm trocar一个，5 mm无气阀的塑胶软管2个，5 mm弧形电钩、弧形分离钳、直形抓钳各一把，柳叶刀可弯曲单孔器械。其余与常规腹腔镜器械相同。
, 百拇医药
1.3切口设置 经脐部做弧形切口约20 mm，切开皮肤和皮下组织，保持深部筋膜完整，于切口正中置入10 mm trocar，于两侧置入5 mm塑胶软管，10 mm trocar为观察孔，左侧缘5 mm塑胶软管为主操作孔，右侧缘5 mm塑胶软管为辅助操作孔，三孔不相通，三者之间呈三角形。
1.4方法 术前准备和麻醉方法同常规腹腔镜胆囊切除术。患者取头高脚低30°、左侧倾斜15°，传统体位或两腿分开皆可，术者立于患者左侧，将胆囊壶腹向左上方拉起，以电凝钩胆囊管处浆膜，胆囊三角前、后腹膜，用弧形分离钳分离出胆囊管，确认胆囊管、胆总管和肝总管三管关系无误后，距胆总管0.5 cm处用hem-o-lok夹夹闭胆囊管，远端再用hem-o-lok夹夹闭胆囊管，于两夹之间剪断胆囊管。再分离出胆囊动脉，用hem-o-lok夹夹闭后切断或直接用超声刀切断。向左上方推起胆囊管远端，自胆囊床逐步分离胆囊。
2 结果
手术均获成功，无中转开腹病例。手术时间45～120 min，无出血、胆漏、胆管损伤等并发症，术后2～3 d出院。, 百拇医药(蔡烈)