CAJ | 학술논문

目的近年经脐入路内镜手术(transumbilical endoscopic surgery,TUES)成为微创外科技术研究热点.其存在的主要问题是脐周围狭小区域内器械之间的相互冲突造成的操作困难.笔者尝试用改进的器械实现腹壁完全无可见瘢痕的经脐入路腹腔镜胆囊切除术.方法 54例胆囊疾病(胆囊息肉13例,结石41例)病人行TUES胆囊切除术.沿脐周呈倒三角形置入2只改进的5 mm操作套管和1只普通5 mm套管.分别置入5 mm腹腔镜和加长的操作器械完成TUES胆囊切除.结果所有病例手术均获成功.无中转常规腹腔镜或开腹手术.手术时间25～56 min,平均(34±28)min.所选病例均未放置引流.无出血、胆漏等并发症发生.除脐部皱折部位外,基本无可见的腹壁瘢痕.结论用改进的器械行经脐入路腹腔镜胆囊切除术,可以克服脐周器械之间的外部冲突,使该技术操作难度大为降低.
목적 근년경제입로내경수술(transumbilical endoscopic surgery,TUES)성위미창외과기술연구열점.기존재적주요문제시제주위협소구역내기계지간적상호충돌조성적조작곤난.필자상시용개진적기계실현복벽완전무가견반흔적경제입로복강경담낭절제술.방법 54례담낭질병(담낭식육13례,결석41례)병인행TUES담낭절제술.연제주정도삼각형치입2지개진적5 mm조작투관화1지보통5 mm투관.분별치입5 mm복강경화가장적조작기계완성TUES담낭절제.결과 소유병례수술균획성공.무중전상규복강경혹개복수술.수술시간25～56 min,평균(34±28)min.소선병례균미방치인류.무출혈、담루등병발증발생.제제부추절부위외,기본무가견적복벽반흔.결론 용개진적기계행경제입로복강경담낭절제술,가이극복제주기계지간적외부충돌,사해기술조작난도대위강저.
Objective The major barrier to transumbilical endoscopic surgery is from external interference between the instruments handles around the umbilicus. We describe the technique of totally transumbilical endoscopic cholecystectomy by using improved instruments. Methods 54 cases of transumbilical laparoscopic cholecystectomy were performed with improved instruments in patients with gallbladder polyps (13 cases) and gallstones (41 cases). The new trocars without the proximal seal system on the sleeves were designed for this procedure. The instruments used in this study were 5 cm longer than commercially available ones. Results All the gallbladders were removed successfully without severe intraoperative bleeding during and postoperative complications. Mean operating time was 25-56 min (average 34±28 min). All the patients were satisfied with the abdominal cosmetic results, discharged 48 h after the operations, and returned to work within seven postoperative days.Conclusions The external interference between trocars and instruments can be partially avoided by using the improved instruments. Totally transumbilical laparoscopic cholecystectomy becomes feasible by this technique.