中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2014年
9期
687-690
,共4页
吴硕东%姚殿波%韩金岩%吕超
吳碩東%姚殿波%韓金巖%呂超
오석동%요전파%한금암%려초
胆囊疾病%腹腔镜检查%逆行胆囊切除术%胆管损伤
膽囊疾病%腹腔鏡檢查%逆行膽囊切除術%膽管損傷
담낭질병%복강경검사%역행담낭절제술%담관손상
Biliary diseases%Laparoscopy%Retrograde cholecystectomy%Bile duct injury
目的 探讨单孔腹腔镜逆行胆囊切除术的临床疗效.方法 回顾性分析2009年5月至2012年12月中国医科大学附属盛京医院收治的979例胆囊疾病患者的临床资料.其中2009年收治51例、2010年收治265例、2011年收治374例、2012年收治289例.术前准备同多孔LC.手术时,选择脐部正中切口,行单孔腹腔镜逆行胆囊切除术.游离胆囊体和底部后,游离、拉直胆囊管,与胆总管呈垂直,2枚hem-o-lock夹钳夹胆囊管近端后,超声刀凝切胆囊管,切除胆囊.术后护理同多孔LC.采用电话和门诊随访,随访患者切口感染、切口疝、切口疼痛、切口美观满意度等,随访时间截至2013年3月.结果 979例患者无中转开腹手术,20例患者因炎症较重中转为多孔LC,其中2009年3例(5.88％),2010年5例(1.89％),2011年5例(1.34％),2012年7例(2.42％).959例患者平均手术时间为48.5 min,术中出血量为(27±25) mL.其中2009年、2010年、2011年、2012年的平均手术时间分别为51.8 min、49.2 min、48.9 min、46.7 min,术中出血量分别为35.0 mL、32.1 mL、33.8 mL、22.9 mL.患者术后疼痛较轻,4.90％ (47/959)的患者使用止痛药物,其中2009年5例,2010年12例,2011年18例,2012年12例.959例患者中仅有4例术后脐部有轻度红肿,经换药治疗后痊愈.2010年至2011年的手术患者中有3例出现胆管损伤,2例术中发现及时修补,1例保守引流后痊愈.患者术后平均肛门排气时间为2.2d,平均住院时间为4.2d.924例患者获得随访,随访时间为1～3个月.随访期间患者术后瘢痕隐藏在脐内,均无切口疝发生.结论 单孔腹腔镜逆行胆囊切除术安全有效,切口隐蔽.
目的 探討單孔腹腔鏡逆行膽囊切除術的臨床療效.方法 迴顧性分析2009年5月至2012年12月中國醫科大學附屬盛京醫院收治的979例膽囊疾病患者的臨床資料.其中2009年收治51例、2010年收治265例、2011年收治374例、2012年收治289例.術前準備同多孔LC.手術時,選擇臍部正中切口,行單孔腹腔鏡逆行膽囊切除術.遊離膽囊體和底部後,遊離、拉直膽囊管,與膽總管呈垂直,2枚hem-o-lock夾鉗夾膽囊管近耑後,超聲刀凝切膽囊管,切除膽囊.術後護理同多孔LC.採用電話和門診隨訪,隨訪患者切口感染、切口疝、切口疼痛、切口美觀滿意度等,隨訪時間截至2013年3月.結果 979例患者無中轉開腹手術,20例患者因炎癥較重中轉為多孔LC,其中2009年3例(5.88％),2010年5例(1.89％),2011年5例(1.34％),2012年7例(2.42％).959例患者平均手術時間為48.5 min,術中齣血量為(27±25) mL.其中2009年、2010年、2011年、2012年的平均手術時間分彆為51.8 min、49.2 min、48.9 min、46.7 min,術中齣血量分彆為35.0 mL、32.1 mL、33.8 mL、22.9 mL.患者術後疼痛較輕,4.90％ (47/959)的患者使用止痛藥物,其中2009年5例,2010年12例,2011年18例,2012年12例.959例患者中僅有4例術後臍部有輕度紅腫,經換藥治療後痊愈.2010年至2011年的手術患者中有3例齣現膽管損傷,2例術中髮現及時脩補,1例保守引流後痊愈.患者術後平均肛門排氣時間為2.2d,平均住院時間為4.2d.924例患者穫得隨訪,隨訪時間為1～3箇月.隨訪期間患者術後瘢痕隱藏在臍內,均無切口疝髮生.結論 單孔腹腔鏡逆行膽囊切除術安全有效,切口隱蔽.
목적 탐토단공복강경역행담낭절제술적림상료효.방법 회고성분석2009년5월지2012년12월중국의과대학부속성경의원수치적979례담낭질병환자적림상자료.기중2009년수치51례、2010년수치265례、2011년수치374례、2012년수치289례.술전준비동다공LC.수술시,선택제부정중절구,행단공복강경역행담낭절제술.유리담낭체화저부후,유리、랍직담낭관,여담총관정수직,2매hem-o-lock협겸협담낭관근단후,초성도응절담낭관,절제담낭.술후호리동다공LC.채용전화화문진수방,수방환자절구감염、절구산、절구동통、절구미관만의도등,수방시간절지2013년3월.결과 979례환자무중전개복수술,20례환자인염증교중중전위다공LC,기중2009년3례(5.88％),2010년5례(1.89％),2011년5례(1.34％),2012년7례(2.42％).959례환자평균수술시간위48.5 min,술중출혈량위(27±25) mL.기중2009년、2010년、2011년、2012년적평균수술시간분별위51.8 min、49.2 min、48.9 min、46.7 min,술중출혈량분별위35.0 mL、32.1 mL、33.8 mL、22.9 mL.환자술후동통교경,4.90％ (47/959)적환자사용지통약물,기중2009년5례,2010년12례,2011년18례,2012년12례.959례환자중부유4례술후제부유경도홍종,경환약치료후전유.2010년지2011년적수술환자중유3례출현담관손상,2례술중발현급시수보,1례보수인류후전유.환자술후평균항문배기시간위2.2d,평균주원시간위4.2d.924례환자획득수방,수방시간위1～3개월.수방기간환자술후반흔은장재제내,균무절구산발생.결론 단공복강경역행담낭절제술안전유효,절구은폐.
Objective To investigate the clinical efficacy of transumbilical single-incision retrograde laparoscopic cholecystectomy.Me,otis The clinical data of 979 patients with gallbladder diseases who were admitted to the Shengjing Hospital of China Medical University from May 2009 to December 2012 were retrospectively analyzed.The numbers of patients who were admitted in the year of 2009,2010,2011 and 2012 were 51,265,374,289,respectively.The preoperative preparation of transumbilical single-incision retrograde laparoscopic cholecystectomy was similar to that of traditional multi-portal laparoscopic surgery.During the operation,the umbilical incision was selected.After the body and bottom of the gallbladder was dissociated,the cystic duct of gallbladder was dissociated and straightened,which was vertical to the common bile duct.After clipping the proximal part of the cystic duct of gallbladder with 2 hem-o-lock clips,the cystic duct was cut off with the ultrasonic knife,and then the gallbladder was removed.Postoperative nursing was also similar to that of traditional laparoscopic cholecystectomy.Patients were followed up via phone call or out-patient examination till March 2013.The wound infection,incisional hernia,incisional pain,cosmetic benefits were observed.Results No patient was converted to open surgery.Twenty patients were converted to multi-portal laparoscopic cholecystectomy because of severe inflammation (3 patients in 2009,5 in 2010,5 in 2011 and 7 in 2012).The mean operation time and volume of blood loss of the 959 patients were 48.5 minutes and (27 ± 25) mL.The operation time in 2009,2010,2011 and 2012 were 51.8 minutes,49.2 minutes,48.9 minutes and 46.7 minutes.The volumes of blood loss in 2009,2010,2011 and 2012 were 35.0 mL,32.1 mL,33.8 mL and 22.9 mL,respectively.The postoperative pain was slight.Forty-seven patients were administered antalgesics (5 in 2009,12 in 2010,18 in 2011 and 12 in 2012).In the 959 patients,umbilical swelling occurred in 4 patients,and was cured by disinfection treatment.Bile duct injury occurred in 3 patients from 2010 to 2011,timely repair wad done in 2 patients,and 1 was cured by drainage.The mean time of postoperative exhuast time and duration of hospital stay were 2.2 days and 4.2 days.A total of 924 patients were followed up for 1-3 months.The scar was hidden in the navel,and no incisional hernia occurred.Conclusion Transumbilical single-incision retrograde laparoscopic cholecystectomy is safe and effective with cosmetic benefits.
