目的 比较单孔法与三孔法腹腔镜胆囊切除术的疗效。方法 2013-01至2013-12我院按单孔法手术适应证收治胆囊良性疾病68例,按患者意愿分组后分别行经脐单孔多通道法(n=36)和三孔法(n=32例)腹腔镜胆囊切除术,比较两组手术时间、术中出血量、取胆囊时间、手术并发症发生情况、术后进食时间、术后疼痛评分、术后切口满意度,以及住院时间、住院费用等。结果 单孔法组有4例因胆囊三角解剖困难改行三孔法完成手术,其余患者均顺利完成手术,无并发症发生,无中转开腹手术。两组在术中出血量、手术并发症发生情况、术后进食时间等方面差异无统计学意义。在其他指标方面,单孔法和三孔法手术时间分别为(50.7±25.4)min和(25.4±8.5)min,疼痛评分分别为 (1.2±0.5)分和(2.7±0.6)分,术后切口满意度分别为(4.4±0.6)分和(3.1±0.8)分,住院费用分别为(6998.9±489.7)元和(8013.4±229.6)元,两组之间差异均有统计学意义(P＜0.01)。结论 常规器械行经脐单孔腹腔镜胆囊切除术是一种疼痛轻、美容效果确切、经济和安全可行的手术方法,但操作相对困难,需具备相当的技术条件及选择合适的病例进行。
Abstract
Objective To compare the efficacy of transumbilical single incision laparoscopic cholecystectomy and and three-port laparoscopic cholecystectomy. Methods From January 2013 to December 2013, 68 patients were recruited and divided into single incision group and three-port group based on the willingness of the patients. Comparative study was condacted on the length of operation time, intraoperative hemorrhage, gallbladder removal time, postoperative complication, postoperative eating time, pain scores, postoperative satisfaction, hospital stay and hospitalization expenses. Results Four patients in single incision group were converted to three-port laparoscopic cholecystectomy. The other patients were successfully operated, without conversion to three-port laparoscopic or open surgery. Compared with three-port group ,the assessment indexes in single incision group including intraoperative hemorrhage and postoperative eating time were not significantly different, while the transumbilical single incision laparoscopic cholecystectomy was associated with a longer operating time (50.7±25.4) minutes versus (25.4±8.5) minutes, less pain (1.2±0.5 versus 2.7±0.6), better cosmetic results (4.4±0.6 versus 3.1±0.8)and less hospitalization expenses (6998.9±489.7 versus 8013.4±229.6)yuan, and the assessment indexes were significantly different(P＜0.05). Conclusions Although the transumbilical single incision laparoscopic cholecystectomy is a difficult procedure, it is a safe and economical technique with superior cosmetic effect. The feasibility of clinical research is determined by the ability of the surgeon, and patients should be selected carefully.
关键词
腹腔镜胆囊切除术 /
胆囊良性疾病 /
常规腹腔镜器械
Key words
laparoscopic cholecystectomy /
benign gallbladder disease /
common laparoscopic equipment
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参考文献
[1] Wewers M E, Lowe N K. A critical review of visual analogue scales in the measurement of clinical phenomena[J]. Res Nurs Health,1990, 13(4):227-236.
[2] Baird J F, Kiyak H A.The uninformed orthodontic patient and parent: treatment outcomes[J]. AM J Orthod Dentofac, 2003, 124(2):212-215.
[3] 郑民华. NOTES与单孔腹腔镜技术的发展现状与展望[J]. 中国微创外科杂志, 2010, 10(1): 18-20.
[4] 张忠涛,郭 伟. 单孔腔镜技术发展带给我们的思考[J]. 中国实用外科杂志, 2011, 31(1): 29-31.
[5] 孙颖浩. 单孔腹腔镜在泌尿外科的发展现状及展望[J]. 中国微创外科杂志, 2010, 10(1): 23-24.
[6] 李 栋,周旭坤,李 平,等. 经脐单孔与三孔法腹腔镜胆囊切除术治疗结石性胆囊炎的对比分析[J]. 中国微创外科杂志, 2012, 12(1): 20-23.
[7] 王蕾蕾,赵振民. 肚脐整形再造的临床应用探讨[J]. 中国美容医学, 2008, 17(1): 149-152.
[8] Ponsky T A.Single port laparoscopic cholecystectomy in adults and children: tools and techniques[J]. Am Coll Surg, 2009, 209(5):e1-e6.
[9] 张显敏,李 栋,李 平, 等. 经脐单孔腹腔镜胆囊切除术前超声评估价值[J]. 中华实用诊断与治疗杂志, 2013, 27(5): 4779-4784.
[10] Rivas H,Varela E, Scott D, et al. Single incision laparoscopic cholecystectomy: initial evaluation of a large series of patients[J] . Surg Endosc, 2010, 24(6): 1403-1412.
[11] Romanelli J R, Roshek T B 3ed, Lynn D C, et al. Single port laparoscopic cholecystectomy: initial experience [J] . Surg Endosc, 2010, 24(6):1374-1379.
[12] 但震宇, 龚仁华, 孙登群, 等. 常规器械经脐单孔腹腔镜胆囊切除术34例[J]. 武警医学, 2012, 23(8): 697-698.
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