CAJ | 학술논문

目的：评价经脐单切口腹腔镜胆囊切除术（TUSILC）的可行性及优越性。方法分析2012年2月至2014年12月112例 TUSILC（单切口组）与同期施行的126例3孔法腹腔镜胆囊切除术（LC）（3孔法组）的临床资料，比较两组的手术时间、术中出血量、术后肠蠕动恢复时间、切口疼痛、并发症、主观满意度和住院时间。结果两组手术均获成功，无中转开腹者，单切口组无中转3孔法。两组术后肠蠕动恢复时间、并发症及住院时间比较，差异无统计学意义（P ＞0．05）。对于慢性胆囊疾病及急性单纯性胆囊炎，两组手术时间、出血量比较，差异无统计学意义（P ＞0．05），但单切口组切口疼痛低于3孔法组（P ＜0．05），主观满意度高于3孔法组（P ＜0．01）。而急性化脓性或坏疽性胆囊炎者，单切口组手术时间明显长于3孔法组（P ＜0．01），出血量多于3孔法组（P ＜0．05），单切口组仅主观满意度高于3孔法组（P ＜0．01）。结论在控制适应证下，TUSILC 安全可行。TUSILC 术后美容效果突出，患者疼痛程度减轻，对已熟练掌握3孔法 LC 的医师来说，不失为一种更好的选择。但3孔法LC，甚至4孔法 LC 在治疗胆囊重度炎症时仍是最佳术式。
목적：평개경제단절구복강경담낭절제술（TUSILC）적가행성급우월성。방법분석2012년2월지2014년12월112례 TUSILC（단절구조）여동기시행적126례3공법복강경담낭절제술（LC）（3공법조）적림상자료，비교량조적수술시간、술중출혈량、술후장연동회복시간、절구동통、병발증、주관만의도화주원시간。결과량조수술균획성공，무중전개복자，단절구조무중전3공법。량조술후장연동회복시간、병발증급주원시간비교，차이무통계학의의（P ＞0．05）。대우만성담낭질병급급성단순성담낭염，량조수술시간、출혈량비교，차이무통계학의의（P ＞0．05），단단절구조절구동통저우3공법조（P ＜0．05），주관만의도고우3공법조（P ＜0．01）。이급성화농성혹배저성담낭염자，단절구조수술시간명현장우3공법조（P ＜0．01），출혈량다우3공법조（P ＜0．05），단절구조부주관만의도고우3공법조（P ＜0．01）。결론재공제괄응증하，TUSILC 안전가행。TUSILC 술후미용효과돌출，환자동통정도감경，대이숙련장악3공법 LC 적의사래설，불실위일충경호적선택。단3공법LC，심지4공법 LC 재치료담낭중도염증시잉시최가술식。
Objective To evaluate the feasibility and advantage of transumbilical single incision laparoscopic cholecystectomy (TUSILC).Methods Analyzing the clinic data of 112 patients accepting TUSILC(SI)vs 126 patients on LC(three-ports TP)from Feb.2012 to Dec.2014,comparing the operation time、the amount of bleeding、recovery time of bowl movement、pain around incision、complications、subjective satisfaction and length of stay between two groups.Results Two groups of operation were success,no conversion to laparotomy and no conversion from SI to TP.There is no statistically significant difference between SI and TP in recovery time of bowl movement、complications and length of stay (P >0.05).No statistically significant difference between SI and TP about the operation time and the amount of bleeding in patients suffering chronic gallbladder disease and acute simple cholecystitis,whereas pain scores of SI is lower than TP(P <0.05),subjective satisfaction better than TP(P <0.01 ).In acute suppurative or gangrenous cholecystitis,the operation time of SI is obviously longer than TP(P <0.01),while the amount of bleeding is more than TP (P <0.05 ),only remaining the better subjective satisfaction (P <0.01).Conclusion TUSILC is safe and feasible under the control of indications.It is a better choice to the doctors who have already had experiences in three ports LC with its less pain and prominent cosmetic efficacy post surgery.But to patients suffering severe cholecystitis,three ports even four ports LC is better.