CAJ | 학술논문

目的：探讨经脐辅助腹壁微小瘢痕行腹腔镜胆囊切除术( LC)的可行性和应用前景。方法回顾性分析2010年9月—2012年7月六安市立医院普外科收治的321例胆囊良性疾病患者的临床资料,其中经脐辅助腹壁微小瘢痕行LC 236例为A组,行经脐单孔LC 85例患者为B组。选取2009年8月—2010年8月胆囊良性疾病行常规法LC 152例患者为对照组( C组)。对比分析3组在手术时间、术中出血量、下床活动时间、进食时间、患者对切口美容的满意度、并发症发生率等指标。结果 A组236例中,226例成功完成手术,10例术中转改为三孔LC,手术中转率4.24%(10/236)。B组85例中,77例成功完成手术,7例术中改为两孔、1例改为三孔LC,手术中转率9.41%(8/85)。C组152例,均成功完成手术,无一例中转其他术式。3组患者均无出血、胆漏、胆管损伤等并发症。3组间比较,术中出血量、术后进食时间差异均无统计学意义(P值均>0.05)；与C组比较,A、B组下床活动时间早、住院时间少、美容满意度高,差异均有统计学意义(P值均<0.01)；A、B两组间比较, A组手术时间少于B组,差异有统计学意义(P<0.01)。结论经脐辅助腹壁微小瘢痕行LC,适应证更广,手术难度较低,操作方法简单易学,安全性高,术后腹壁瘢痕微小,患者满意度高,值得临床推广应用。
목적：탐토경제보조복벽미소반흔행복강경담낭절제술( LC)적가행성화응용전경。방법회고성분석2010년9월—2012년7월륙안시립의원보외과수치적321례담낭량성질병환자적림상자료,기중경제보조복벽미소반흔행LC 236례위A조,행경제단공LC 85례환자위B조。선취2009년8월—2010년8월담낭량성질병행상규법LC 152례환자위대조조( C조)。대비분석3조재수술시간、술중출혈량、하상활동시간、진식시간、환자대절구미용적만의도、병발증발생솔등지표。결과 A조236례중,226례성공완성수술,10례술중전개위삼공LC,수술중전솔4.24%(10/236)。B조85례중,77례성공완성수술,7례술중개위량공、1례개위삼공LC,수술중전솔9.41%(8/85)。C조152례,균성공완성수술,무일례중전기타술식。3조환자균무출혈、담루、담관손상등병발증。3조간비교,술중출혈량、술후진식시간차이균무통계학의의(P치균>0.05)；여C조비교,A、B조하상활동시간조、주원시간소、미용만의도고,차이균유통계학의의(P치균<0.01)；A、B량조간비교, A조수술시간소우B조,차이유통계학의의(P<0.01)。결론경제보조복벽미소반흔행LC,괄응증경엄,수술난도교저,조작방법간단역학,안전성고,술후복벽반흔미소,환자만의도고,치득림상추엄응용。
Objective To investigate the feasibility and application prospect of the transumbilical assisted abdominal wall small scar laparoscopic cholecystectomy( LC) . Methods Retrospective analysis of clinical data of 321 patients of benign gallbladder diseases in Department of General Surgery, Lu’an Municiple Hospital from September 2010 to July 2012. 236 patients treated by transumbilical assisted abdominal wall small scar LC were classified as group A. The 85 patients underwent transumbilical single port LC classified as group B. The 152 patients of benign gallbladder disease underwent conventional LC from August 2009 to August 2010 were classified as control group ( group C) . The operation time, amount of bleeding during the operation, ambulation time, eating time, patient satisfaction, beauty of incision complication rate and other indicators were compared in 3 groups. Results In group A, 226 patients were operated successfully, 10 patients were converted to 3 holes, the operation rate of 4. 23%(10/236). In group B, 77 patients were operated successfully, 7 patients changed to 2 holes, 1 patient changed to 3 holes, the operation rate of 9. 41%(8/85). In group C, 152 patients were operated successfully, without conversions to open surgery. All the patients had no bleeding, bile leakage, bile duct injury and other complications. There were no statistically significant differences in bleeding volume and postoperative after eating time in 3 groups (all P values>0. 05). The early ambulation, less hospitalization time and beauty in group A and B were satisfactory compared with group C, the difference was statistically significant ( all P values<0. 01). The operation time in group A was less than that in group B, the difference was statistically significant (P<0. 01). Conclusions The transumbilical assisted abdominal wall small scar laparoscopic cholecystectomy has some advantages such as wide indications, easy and simple operation, high safety, small postoperative abdominal wall scar small, high patient satisfaction and worthy of clinical application.