Clinical effect of transumbilical single-port laparoscopic cholecystectomy versus conventional three-trocar laparoscopic cholecystectomy with three holes: a comparative analysis
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摘要: 目的探讨经脐单孔腹腔镜胆囊切除术与传统三孔法腹腔镜胆囊切除术的效果。方法选取2015年1月-2016年12月延安市人民医院收治的胆囊结石和胆囊息肉患者62例,按住院单双号分为2组,三孔组(n=32)采用三孔法腹腔镜胆囊切除术,单孔组(n=30)采用单孔腹腔镜胆囊切除术。对比分析2组患者手术时间,术中出血量,腹壁美容度评分,术前和术后1、3 d的视觉模拟量表(VAS)评分,镇痛药使用情况,术前和术后24 h肝功能指标ALT、AST、ALP水平,住院费用及随访1个月并发症发生情况。计量资料组内比较采用配对t检验,2组间比较采用t检验,计数资料2组间比较采用χ2检验。结果单孔组患者术后腹壁美容度评分高于三孔组[(4.89±0.10)分vs(3.15±0.34)分,t=4.910,P=0.039],术后住院时间短于三孔组[(2.58±0.53)d vs(4.35±0.24)d,t=-5.459,P=0.032],手术时间长于三孔组[(78.15±4.21)min vs(50.84±5.12)min,t=4.455,P=0.047],术后1、3 d的VAS评分低于三孔组[(...Abstract: Objective To investigate the clinical effect of transumbilical single-port laparoscopic cholecystectomy versus conventional three-trocar conventional laparoscopic cholecystectomy. Methods A total of 62 patients with gallstones or gallbladder polyps who were admitted to Yan'an People's Hospital from January 2015 to December 2016 were enrolled, and according to the admission number, these patients were divided into three-trocar group with 32 patients treated with laparoscopic cholecystectomy with three holes and single-port group with 30 patients treated with single-port laparoscopic cholecystectomy. The two groups were compared in terms of time of operation, intraoperative blood loss, abdominal wall beauty score, Visual Analogue Scale ( VAS) score before surgery and at 1 and 3 days after surgery, application of analgesics, levels of liver function parameters alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , and alkaline phosphatase ( ALP) before surgery and at 24 hours after surgery, hospital costs, and complications during the 1-month follow-up. The t-test was used for comparison of continuous data between groups, and the matched t-test was used for comparison before and after treatment. The chi-square test was used for comparison of categorical data between groups. Results Compared with the three-trocar group, the single-port group had a significantly higher abdominal wall beauty score after treatment ( 4. 89 ± 0. 10 vs 3. 15 ± 0. 34, t = 4. 910, P = 0. 039) , a significantly shorter length of postoperative hospital stay ( 2. 58 ± 0. 53 d vs 4. 35 ± 0. 24 d, t =-5. 459, P = 0. 032) , a significantly longer time of operation ( 78. 15 ± 4. 21 min vs 50. 84 ± 5. 12 min, t = 4. 455, P = 0. 047) , a significantly lower VAS score at 1 and 3 days after surgery ( at 1 day after surgery: 4. 72 ± 0. 58 vs 6. 37 ± 0. 45, t =-7. 060, P < 0. 001; at 3 days after surgery: 3. 24 ± 0. 83 vs 5. 45 ± 0. 94, t =-4. 644, P < 0. 001) , and a significantly lower proportion of patients who used analgesics ( 20. 0% vs 37. 5%, χ2= 6. 768, P = 0. 009) .Both groups had significant increases in the levels of ALT, AST, and ALP after surgery, and the single-port group had significantly lower levels than the three-trocar group ( all P < 0. 001) . During the 1-month follow-up, there was no significant difference in the incidence rate of complications between the two groups ( P > 0. 05) . Conclusion Transumbilical sing-port laparoscopic cholecystectomy has small surgical trauma and invisible scars after surgery. Patients feel little pain and are satisfied with the appearance of skin at the surgical site.This surgical procedure does not increase complications and has little influence on liver function. It needs a longer time of operation compared with three-trocar laparoscopic cholecystectomy.
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Key words:
- cholecystolithiasis /
- polyps /
- cholecystectomy, laparoscopic /
- treatment outcome
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[1]LI XX, GUO Q.The implementation of high quality nursing care for patients after laparoscope cholecystectomy[J].Med Innov Chin, 2015, 12 (2) :92-94. (in Chinese) 李小香, 郭琪.优质护理在腹腔镜胆囊切除术后患者护理中的实施[J].中国医学创新, 2015, 12 (2) :92-94. [2]LI RB, LI YR, WAN ZH, et al.Clinical feasibility of transumbilical single-port laparoscopic cholecystectomy[J].Chin J Gen Surg, 2015, 24 (8) :1125-1129. (in Chinese) 李瑞斌, 李艳茹, 万智恒, 等.经脐单孔腹腔镜下胆囊切除术的临床可行性研究[J].中国普通外科杂志, 2015, 24 (8) :1125-1129. [3]HUANG ZY, ZENG DD, ZHONG YY, et al.Study on the skin preparation of laparoscopic operation of the umbilical cord without scar[J].Chin J Dis infection Sci, 2016, 33 (1) :21-23. (in Chinese) 黄泽云, 曾多多, 钟艳媛, 等.经脐无疤痕腹腔镜手术术前皮肤准备研究[J].中国消毒学杂志, 2016, 33 (1) :21-23. [4]ZHAO Q, LI Y, PEI GC, et al.Comparative study of transumbilical hole and the traditional three-hole for laparoscopic cholecystectomy[J].Anat Clin, 2013, 18 (6) :488-491. (in Chinese) 赵强, 李钰, 裴根仓, 等.经脐单孔与传统三孔腹腔镜胆囊切除术的对比研究[J].解剖与临床, 2013, 18 (6) :488-491. [5]TU SL, YUAN H.Key technologies and surgical techniques of laparoscopic radical resection in the treatmant for rectal cancer[J].JChin Oncol, 2015, 21 (2) :101-105. (in Chinese) 屠世良, 袁航.腹腔镜直肠癌根治术的关键技术和手术技巧[J].肿瘤学杂志, 2015, 21 (2) :101-105. [6]CAO LZ.Comparasion of operative effect of transumbilical single hole laparoscopic method and the three hole laparoscopic cholecystectomy[J].Henan J Surg, 2015, 21 (4) :13-15. (in Chinese) 曹连中.经脐单孔与三孔法腹腔镜胆囊切除术疗效比较[J].河南外科学杂志, 2015, 21 (4) :13-15. [7]YAN CH, XU YC.Laparoscopic cholecystectomy on liver function and stress reaction[J].J Changchun Univ Chin Med, 2016, 32 (1) :171-173. (in Chinese) 闫长红, 许艳春.胆囊结石行腹腔镜胆囊切除术对肝功能及应激反应的影响[J].长春中医药大学学报, 2016, 32 (1) :171-173. [8]HUANG LL, OU H, WANG R.A report of 30 cases of trasumbilical three-port laparoscopic salpingectomy without visible scars[J].J Minim Invas Med, 2015, 10 (4) :463-465. (in Chinese) 黄玲玲, 欧红, 王润.经脐三孔无瘢痕腹腔镜输卵管切除术30例报告[J].微创医学, 2015, 10 (4) :463-465. [9]YE G, QIN Y, XU S, et al.Comparison of transumbilical singleport laparoscopic cholecystectomy and fourth-port laparoscopic cholecystectomy[J].Int J Clin Exp Med, 2015, 8 (5) :7746-7753. [10]WANG DY, XU Y, HAN MM, et al.Clinical effect of TUES on the treatment of acute cholecystitis[J].Prog Mod Biomed, 2015, 15 (23) :4481-4483. (in Chinese) 王大东, 许勇, 韩明明, 等.经脐单孔腹腔镜辅助整形术治疗急性胆囊炎的临床效果[J].现代生物医学进展, 2015, 15 (23) :4481-4483. [11]YAO M, CAI XY.Application of single-port laparoscopic surgery in general surge[J].J Minim Invas Med, 2014, 9 (1) :90-93. (in Chinese) 姚明, 蔡小勇.单孔腹腔镜技术在普通外科的应用[J].微创医学, 2014, 9 (1) :90-93. [12]ZHAO L.Clinical application of transumbilical single port laparoscopic cholecystectomy and its safety[J].Chin J Med Offic, 2015, 43 (5) :513-515. (in Chinese) 赵雷.经脐单孔腹腔镜胆囊切除术的临床应用及安全性探讨[J].临床军医杂志, 2015, 43 (5) :513-515.
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