CAJ | 학술논문

目的：探讨经脐单孔腹腔镜胆囊切除术及术中超声刀直接处理胆囊动脉的临床可行性及使用价值。方法回顾性分析本科室自2011年3月-2012年12月施行腹腔镜胆囊切除术并术中超声刀直接处理胆囊动脉231例患者的临床资料。根据患者要求手术方式分为经脐单孔腔镜组125例（A组）和三孔腔镜组106例（B组），比较2种术式的手术时间、术中出血量、术后镇痛、术后进食、术后住院时间、术后并发症发生情况以及超声刀直接处理胆囊动脉的效果。计量资料组间比较采用t检验，计数资料比较采用卡方检验。结果 A组手术时间平均为（20．21±1．86）min，长于B组的（18．43±1．37）min，差异有统计学意义（P＜0．05）；A组术中出血量平均为（23．23±6．25）ml，B组为（22．34±5．49）ml，差异无统计学意义（P＞0．05）；A组术后5例须要镇痛，B组21例，差异有统计学意义（P＜0．05）；A组术后进食时间为（6．56±1．23）h，B组为（6．67±1．45）h，差异无统计学意义（P＞0．05）；A组术后住院平均时间为（2．98±0．23）d，B组为（3．02±0．18）d，差异无统计学意义（P＞0．05）；2组患者术后均未留置引流管。2组术后均无出血、胆管损伤、胆漏及切口感染等并发症发生。超生刀直接凝断胆囊动脉止血效果可靠，术后无继发性出血发生。所有患者术后随访2～12个月，平均6．5个月，患者康复良好，无切口疝发生，脐部瘢痕不明显，美容效果较好。结论经脐单孔腹腔镜胆囊切除术具有三孔腹腔镜胆囊切除术相同临床效果，并且具有创伤小，术后疼痛轻、美容效果好等优势，特别适用外貌美容要求较高的患者。超声刀直接离断胆囊动脉能够减少由于仔细分离胆囊动脉而意外造成的大出血，同时也相应缩短手术时间，是一种安全、可行的手术方式，值得临床推广应用。目的：探討經臍單孔腹腔鏡膽囊切除術及術中超聲刀直接處理膽囊動脈的臨床可行性及使用價值。方法迴顧性分析本科室自2011年3月-2012年12月施行腹腔鏡膽囊切除術併術中超聲刀直接處理膽囊動脈231例患者的臨床資料。根據患者要求手術方式分為經臍單孔腔鏡組125例（A組）和三孔腔鏡組106例（B組），比較2種術式的手術時間、術中齣血量、術後鎮痛、術後進食、術後住院時間、術後併髮癥髮生情況以及超聲刀直接處理膽囊動脈的效果。計量資料組間比較採用t檢驗，計數資料比較採用卡方檢驗。結果 A組手術時間平均為（20．21±1．86）min，長于B組的（18．43±1．37）min，差異有統計學意義（P＜0．05）；A組術中齣血量平均為（23．23±6．25）ml，B組為（22．34±5．49）ml，差異無統計學意義（P＞0．05）；A組術後5例鬚要鎮痛，B組21例，差異有統計學意義（P＜0．05）；A組術後進食時間為（6．56±1．23）h，B組為（6．67±1．45）h，差異無統計學意義（P＞0．05）；A組術後住院平均時間為（2．98±0．23）d，B組為（3．02±0．18）d，差異無統計學意義（P＞0．05）；2組患者術後均未留置引流管。2組術後均無齣血、膽管損傷、膽漏及切口感染等併髮癥髮生。超生刀直接凝斷膽囊動脈止血效果可靠，術後無繼髮性齣血髮生。所有患者術後隨訪2～12箇月，平均6．5箇月，患者康複良好，無切口疝髮生，臍部瘢痕不明顯，美容效果較好。結論經臍單孔腹腔鏡膽囊切除術具有三孔腹腔鏡膽囊切除術相同臨床效果，併且具有創傷小，術後疼痛輕、美容效果好等優勢，特彆適用外貌美容要求較高的患者。超聲刀直接離斷膽囊動脈能夠減少由于仔細分離膽囊動脈而意外造成的大齣血，同時也相應縮短手術時間，是一種安全、可行的手術方式，值得臨床推廣應用。
목적：탐토경제단공복강경담낭절제술급술중초성도직접처리담낭동맥적림상가행성급사용개치。방법회고성분석본과실자2011년3월-2012년12월시행복강경담낭절제술병술중초성도직접처리담낭동맥231례환자적림상자료。근거환자요구수술방식분위경제단공강경조125례（A조）화삼공강경조106례（B조），비교2충술식적수술시간、술중출혈량、술후진통、술후진식、술후주원시간、술후병발증발생정황이급초성도직접처리담낭동맥적효과。계량자료조간비교채용t검험，계수자료비교채용잡방검험。결과 A조수술시간평균위（20．21±1．86）min，장우B조적（18．43±1．37）min，차이유통계학의의（P＜0．05）；A조술중출혈량평균위（23．23±6．25）ml，B조위（22．34±5．49）ml，차이무통계학의의（P＞0．05）；A조술후5례수요진통，B조21례，차이유통계학의의（P＜0．05）；A조술후진식시간위（6．56±1．23）h，B조위（6．67±1．45）h，차이무통계학의의（P＞0．05）；A조술후주원평균시간위（2．98±0．23）d，B조위（3．02±0．18）d，차이무통계학의의（P＞0．05）；2조환자술후균미류치인류관。2조술후균무출혈、담관손상、담루급절구감염등병발증발생。초생도직접응단담낭동맥지혈효과가고，술후무계발성출혈발생。소유환자술후수방2～12개월，평균6．5개월，환자강복량호，무절구산발생，제부반흔불명현，미용효과교호。결론경제단공복강경담낭절제술구유삼공복강경담낭절제술상동림상효과，병차구유창상소，술후동통경、미용효과호등우세，특별괄용외모미용요구교고적환자。초성도직접리단담낭동맥능구감소유우자세분리담낭동맥이의외조성적대출혈，동시야상응축단수술시간，시일충안전、가행적수술방식，치득림상추엄응용。
Objective To investigate the clinical feasibility and value of transumbilical single-port laparoscopic cholecystectomy with intra-operative ultrasonic knife for directly handling the cystic artery.Methods A retrospective analysis was performed on the clinical data of 23 1 patients who underwent laparoscopic cholecystectomy with intraoperative ultrasonic knife for directly handling the cystic artery in our depart-ment from March 201 1 to December 2012.According to the required surgical approaches,the patients were divided into transumbilical single-port laparoscopic group (n=125,group A)and three-port laparoscopic group (n=106,group B).The two groups were compared in terms of operative time,intraoperative blood loss,postoperative analgesia,postoperative food intake,length of postoperative hospital stay, and postoperative complications,as well as the performance of the ultrasonic knife in directly handling the cystic artery.Comparison of con-tinuous data between groups was made by t test,while comparison of categorical data was made by chi-square test.Results Group A had a significantly longer mean operative time than group B (20.21 ±1.86 min vs 18.43 ±1.37 min,P<0.05).There was no significant difference in mean intraoperative blood loss between groups A and B (23.23 ±6.25 ml vs 22.34 ±5.49 ml,P>0.05).Group A had sig-nificantly fewer patients who needed postoperative analgesia than group B (5 vs 21,P<0.05).The time to postoperative food intake showed no significant difference between groups A and B (6.56 ±1.23 h vs 6.67 ±1.45 h,P>0.05).The mean length of postoperative hospital stay was (2.98 ±0.23)d in group A,versus (3.02 ±0.18)d in group B (P>0.05).No indwelling drainage tube was used after opera-tion in either group.There were no postoperative bleeding,bile duct injury,bile leakage,incisional wound infection,and other complica-tions in the two groups.The ultrasonic knife had reliable hemostatic effect when directly sealing the cystic artery,without causing postopera-tive secondary bleeding.All patients were followed up for 2-12 months (mean,6.5 months);they recovered well without incisional herni-a,and the umbilical scar was not obvious,with relatively good cosmetic results.Conclusion Transumbilical single -port laparoscopic cholecystectomy has a comparable clinical effect to three-port laparoscopic cholecystectomy,causing little trauma,postoperative pain,and scar,and it is suitable for patients with a high demand for incision appearance.Directly sealing the cystic artery with the ultrasonic knife can reduce bleeding due to careful separation of the cystic artery and shorten the operative time.Therefore,it is a safe,feasible surgical ap-proach and worthy of clinical application.