CAJ | 학술논문

目的：探讨经脐入路腹腔镜胆囊切除术的可行性、安全性。方法回顾性分析2007年11月～2014年9月3000例经脐三套管法腹腔镜胆囊切除术的临床资料，其中胆囊结石2308例，胆囊息肉样病变385例，胆囊结石合并胆囊息肉样病变或胆囊腺肌症307例。使用加长直型腹腔镜器械。结果所有患者均成功完成手术，手术时间8～175 min，前2200例手术时间中位数21 min，后800例为12 min，术中出血2～200 ml，中位数18 ml，术后2～5天出院。手术并发症18例，其中2例因术中胆总管部分损伤中转为三孔腹腔镜手术；1例因胆总管横断伤、1例因术中大出血中转开腹；2例因术后腹腔出血、1例因术后胆漏再次三孔腹腔镜手术；胃浆膜灼伤2例、胆漏6例、切口感染3例保守治疗痊愈。无手术死亡。术后1～46个月复诊，瘢痕隐蔽，患者满意，无切口疝发生。结论用加长直型腹腔镜器械行经脐入路腹腔镜胆囊切除术安全可行，美容效果好。
목적：탐토경제입로복강경담낭절제술적가행성、안전성。방법회고성분석2007년11월～2014년9월3000례경제삼투관법복강경담낭절제술적림상자료，기중담낭결석2308례，담낭식육양병변385례，담낭결석합병담낭식육양병변혹담낭선기증307례。사용가장직형복강경기계。결과소유환자균성공완성수술，수술시간8～175 min，전2200례수술시간중위수21 min，후800례위12 min，술중출혈2～200 ml，중위수18 ml，술후2～5천출원。수술병발증18례，기중2례인술중담총관부분손상중전위삼공복강경수술；1례인담총관횡단상、1례인술중대출혈중전개복；2례인술후복강출혈、1례인술후담루재차삼공복강경수술；위장막작상2례、담루6례、절구감염3례보수치료전유。무수술사망。술후1～46개월복진，반흔은폐，환자만의，무절구산발생。결론용가장직형복강경기계행경제입로복강경담낭절제술안전가행，미용효과호。
Objective To investigate the feasibility and safety of transumbilical single-incision laparoscopic cholecystectomy . Methods We retrospectively analyzed clinical data of 3000 cases of transumbilical laparoscopic cholecystectomy performed between November 2007 and September 2014.Among them, there were 2308 cases of gallbladder calculi , 385 cases of gallbladder polyp-like lesions, and 307 cases of gallbladder calculi with gallbladder polyp lesions or adenomyosis .Extended straight laparoscopic instruments were applied in the surgery . Results All the procedures were successfully accomplished .The operation time was 8-175 min.The median operation time was 21 min in the first 2200 cases and 12 min in the remaining 800 cases.The median intraoperative hemorrhage volume was 18 ml (range, 2-200 ml).The patients were discharged 2-5 days after the surgery.A total of 18 cases encountered complications as following:2 cases were given a conversion to 3-trocar procedure due to injury of partial common bile duct ( CBD);1 case of transaction of CBD and 1 case of mass bleeding required conversions to laparotomy; 2 cases of postoperative intraabdominal hemorrhage and 1 case of bile leakage were handled with a subsequent 3-trocar laparoscopy;2 cases of burning injury in gastric serosa , 6 cases of bile leakage , and 3 cases of port-site infection were managed conservatively .No mortality was observed .The patients were followed up for 1 -46 months after surgery , with satisfactory outcomes and concealed scars .No incisional hernia was identified . Conclusion By using ordinary extended straight laparoscopic instruments , transumbilical laparoscopic cholecystectomy is feasible and safe, and has an excellent cosmetic effect .