Clinical efficacy of transumbilical single- port laparoscopic cholecystectomy with ultrasonic knife for directly handling cystic artery
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摘要: 目的探讨经脐单孔腹腔镜胆囊切除术及术中超声刀直接处理胆囊动脉的临床可行性及使用价值。方法回顾性分析本科室自2011年3月-2012年12月施行腹腔镜胆囊切除术并术中超声刀直接处理胆囊动脉231例患者的临床资料。根据患者要求手术方式分为经脐单孔腔镜组125例(A组)和三孔腔镜组106例(B组),比较2种术式的手术时间、术中出血量、术后镇痛、术后进食、术后住院时间、术后并发症发生情况以及超声刀直接处理胆囊动脉的效果。计量资料组间比较采用t检验,计数资料比较采用卡方检验。结果 A组手术时间平均为(20.21±1.86)min,长于B组的(18.43±1.37)min,差异有统计学意义(P<0.05);A组术中出血量平均为(23.23±6.25)ml,B组为(22.34±5.49)ml,差异无统计学意义(P>0.05);A组术后5例须要镇痛,B组21例,差异有统计学意义(P<0.05);A组术后进食时间为(6.56±1.23)h,B组为(6.67±1.45)h,差异无统计学意义(P>0.05);A组术后住院平均时间为(2.98±0.23)d,B组为(3.02±0.18)...Abstract: Objective To investigate the clinical feasibility and value of transumbilical single- port laparoscopic cholecystectomy with intraoperative ultrasonic knife for directly handling the cystic artery.Methods A retrospective analysis was performed on the clinical data of 231 patients who underwent laparoscopic cholecystectomy with intraoperative ultrasonic knife for directly handling the cystic artery in our department from March 2011 to December 2012.According to the required surgical approaches, the patients were divided into transumbilical single- port laparoscopic group (n = 125, group A) and three- port laparoscopic group (n = 106, group B) .The two groups were compared in terms of operative time, intraoperative blood loss, postoperative analgesia, postoperative food intake, length of postoperative hospital stay, and postoperative complications, as well as the performance of the ultrasonic knife in directly handling the cystic artery.Comparison of continuous data between groups was made by t test, while comparison of categorical data was made by chi- square test.Results Group A had a significantly longer mean operative time than group B (20.21 ± 1.86 min vs 18.43 ± 1.37 min, P < 0.05) .There was no significant difference in mean intraoperative blood loss between groups A and B (23.23 ± 6.25 ml vs 22.34 ± 5.49 ml, P > 0.05) .Group A had significantly fewer patients who needed postoperative analgesia than group B (5 vs 21, P < 0.05) .The time to postoperative food intake showed no significant difference between groups A and B (6.56 ± 1.23 h vs 6.67 ± 1.45 h, P > 0.05) .The mean length of postoperative hospital stay was (2.98 ± 0.23) d in group A, versus (3.02 ± 0.18) d in group B (P > 0.05) .No indwelling drainage tube was used after operation in either group.There were no postoperative bleeding, bile duct injury, bile leakage, incisional wound infection, and other complications in the two groups.The ultrasonic knife had reliable hemostatic effect when directly sealing the cystic artery, without causing postoperative secondary bleeding.All patients were followed up for 2- 12 months (mean, 6.5 months) ;they recovered well without incisional hernia, and the umbilical scar was not obvious, with relatively good cosmetic results.Conclusion Transumbilical single- port laparoscopic cholecystectomy has a comparable clinical effect to three- port laparoscopic cholecystectomy, causing little trauma, postoperative pain, and scar, and it is suitable for patients with a high demand for incision appearance.Directly sealing the cystic artery with the ultrasonic knife can reduce bleeding due to careful separation of the cystic artery and shorten the operative time.Therefore, it is a safe, feasible surgical approach and worthy of clinical application.
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Key words:
- cholecystectom, laparoscopic /
- ultrasonics /
- treatment outcome
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