CAJ | 학술논문

目的：探讨自制单孔装置Iconport在经脐单孔腹腔镜胆囊切除术（ laparoscopic cholecystectomy ，LC）中应用的安全性和临床价值。方法绕脐左缘弧形切口2．5～3 cm，开放法进腹，手术钳将自制单孔装置的硅胶密封套折叠后塞入切口实现切口密封，使用常规直杆型腹腔镜器械经Iconport 完成经脐单孔腹腔镜胆囊切除术。术毕标本在单孔装置保护下取出，切口分白线和皮肤两层可吸收线连续缝合。结果40例成功完成单孔手术，10例因胆囊三角粘连严重，解剖结构不清，术野渗血，视野显露不满意等原因增加1个辅助操作孔完成手术。40例单孔手术时间40～65 min，平均45 min；术中出血量5～10 ml。术后均未置腹腔引流。住院时间3～5 d，平均4．2 d。无出血、胆汁漏、胆管及胃肠道损伤、切口感染、切口疝等手术并发症发生。脐部切口愈合后瘢痕处于脐孔边缘弧线外观不明显。50例随访3～6个月，无脐疝发生，切口痕隐于脐孔。结论 Iconport单孔装置密封性能满意，应用于经脐单孔LC中安全可靠，手术瘢痕隐于脐孔。
목적：탐토자제단공장치Iconport재경제단공복강경담낭절제술（ laparoscopic cholecystectomy ，LC）중응용적안전성화림상개치。방법요제좌연호형절구2．5～3 cm，개방법진복，수술겸장자제단공장치적규효밀봉투절첩후새입절구실현절구밀봉，사용상규직간형복강경기계경Iconport 완성경제단공복강경담낭절제술。술필표본재단공장치보호하취출，절구분백선화피부량층가흡수선련속봉합。결과40례성공완성단공수술，10례인담낭삼각점련엄중，해부결구불청，술야삼혈，시야현로불만의등원인증가1개보조조작공완성수술。40례단공수술시간40～65 min，평균45 min；술중출혈량5～10 ml。술후균미치복강인류。주원시간3～5 d，평균4．2 d。무출혈、담즙루、담관급위장도손상、절구감염、절구산등수술병발증발생。제부절구유합후반흔처우제공변연호선외관불명현。50례수방3～6개월，무제산발생，절구흔은우제공。결론 Iconport단공장치밀봉성능만의，응용우경제단공LC중안전가고，수술반흔은우제공。
Objective To discuss the reliability and clinical value of Iconport , a self-made single port device , in the operation of transumbilical single-port laparoscopic cholecystectomy . Methods An arc-incision around half circle along the left umbilical fold was cut , with a length of 2.5-3 cm.Then the skin and each layer of the abdominal wall were cut in sequence .The silica gel sleeve of the self-made single-incision sealing device was folded , clamped by the forceps , and carefully inserted into the incision for sealing . Laparoscopic cholecystectomy was accomplished by using routine linetype laparoscopic instruments via the Iconport .The specimen was discharged from peritoneal cavity through the single-port device , and the incision was sutured successively at linea alba abdominus and skin respectively by absorbable threads . Results A total of 40 cases were operated successfully by single-port laparoscopic cholecystectomy , while the other 10 cases were given an additional assisting port because of serious adhesion in Calot’s triangle, unclarity anatomical structure, oozing of blood in the operating field, and dissatisfied surgical view.The operative time of the 40 cases was 40-65 min, with a mean of 45 min.The intraoperative hemorrhage was 5-10 ml.There was no drainage in peritoneal cavity in all the 50 cases.The hospital stay was 3-5 d, with a mean of 4.2 d.There were no surgical complications , such as bleeding, bile leakage, biliary and gastrointestinal injury, infection of incision, incisional hernia, and so on.Located around the curving margin of the umbilicus , the surgical scars were unapparent in all the 50 cases.The follow-up time of the 50 patients was 3-6 months.None of them had umbilical hernia , and the surgical scars were hidden in the umbilicus . Conclusion The self-made single-port device (brand name:Iconport) is a reliable laparoscopic sealing device , which can be used for transumbilical single-port laparoscopic cholecystectomy .The surgical scars are hidden in the umbilicus .