CAJ | 학술논문

目的：探讨使用常规器械行经脐入路单一部位腹腔镜胆囊切除术（ transumbilical single-site laparoscopic cholecystectomy，TUSLC）与传统腹腔镜术式（traditional laparoscopic cholecystectomy ，TLC）比较的优越性。方法按纳入、排除及剔除标准将武警上海市总队医院2013年9月～2014年3月连续30例非急症腹腔镜胆囊切除术按随机数字表法随机分为TUSLC组（n＝14）和TLC组（n＝16）。2组性别、年龄和体重指数差异无显著性。比较2组手术相关数据、创伤应激指标及疼痛程度。结果2组手术时间、术中失血量、手术并发症、术后住院时间、住院总费用及术后各时相创伤应激指标（C反应蛋白、白介素6、中性粒细胞弹性蛋白酶、肿瘤坏死因子α及白细胞）比较差异均无显著性（P＞0．05）。术后12 h TUSLC组疼痛视觉模拟评分较TLC组低（4．00±0．78 vs．4．75±0．68，t＝－2．800，P＝0．009），术后24 h及48 h时2组差异无显著性（P＞0．05）。结论常规器械TUSLC安全可行。在手术经验丰富的前提下，此方法较传统术式具有一定的总体优势，即在不增加手术费用的基础上，前者具有美容效果肯定、术后短期内疼痛较轻的潜在微创性特点。
목적：탐토사용상규기계행경제입로단일부위복강경담낭절제술（ transumbilical single-site laparoscopic cholecystectomy，TUSLC）여전통복강경술식（traditional laparoscopic cholecystectomy ，TLC）비교적우월성。방법안납입、배제급척제표준장무경상해시총대의원2013년9월～2014년3월련속30례비급증복강경담낭절제술안수궤수자표법수궤분위TUSLC조（n＝14）화TLC조（n＝16）。2조성별、년령화체중지수차이무현저성。비교2조수술상관수거、창상응격지표급동통정도。결과2조수술시간、술중실혈량、수술병발증、술후주원시간、주원총비용급술후각시상창상응격지표（C반응단백、백개소6、중성립세포탄성단백매、종류배사인자α급백세포）비교차이균무현저성（P＞0．05）。술후12 h TUSLC조동통시각모의평분교TLC조저（4．00±0．78 vs．4．75±0．68，t＝－2．800，P＝0．009），술후24 h급48 h시2조차이무현저성（P＞0．05）。결론상규기계TUSLC안전가행。재수술경험봉부적전제하，차방법교전통술식구유일정적총체우세，즉재불증가수술비용적기출상，전자구유미용효과긍정、술후단기내동통교경적잠재미창성특점。
Objective To confirm the superiority of transumbilical single-site laparoscopic cholecystectomy ( TUSLC) with conventional devices via a comparative analysis of surgical data between TUSLC with conventional devices and traditional laparoscopic cholecystectomy ( TLC) . Methods The study prospectively enrolled 30 consecutive elective patients from September 2013 to March 2014 in this hospital.These patients were randomly divided into trial group (TUSLC with conventional devices) (n=14) and control group (TLC) (n=16).Demographic data (including gender constitution, age, and body mass index) between the two groups were not different statistically .Surgical data , post-traumatic stress index , and pain scores between the two groups were compared . Results The surgical data, including operating time, operative blood loss, complications, length of postoperative hospitalization , hospitalization expense, and the post-traumatic stress index per period (C-reactive protein, interleukin-6, neutrophil elastase, tumor necrosis factorα, white blood cell) were not significantly different between the two groups (P>0.05).The pain scores of visual analog scale at 24 h and 48 h postoperatively were not significantly different between the two groups ( P >0.05).However, the pain scores at 12 h postoperatively was lower in the trial group than that in the control group (4.00 ±0.78 vs.4.75 ±0.68, t=-2.800, P=0.009). Conclusion Performance of TUSLC with conventional devices is safe and feasible .Besides the advantages of no more operative costs and definite cosmetic results over TLC , this approach , based on abundant surgical experience , possesses potential minimal invasion .