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中华肝脏外科手术学电子杂志 ›› 2022, Vol. 11 ›› Issue (03) : 304 -308. doi: 10.3877/cma.j.issn.2095-3232.2022.03.018

临床研究

Minilap辅助隐疤痕腹腔镜胆囊切除术在胆囊良性疾病中的应用
刘宇虹1, 邓刚1, 陈阳2, 樊友文1, 陈祖兵1, 姜雅欣1, 汤地1,()   
  1. 1. 518107 深圳,中山大学附属第七医院普通外科
    2. 518000 深圳市龙华区中心医院胃肠肝胆外科
  • 收稿日期:2022-03-31 出版日期:2022-06-10
  • 通信作者: 汤地
  • 基金资助:
    深圳市医学重点学科项目(SZXK092)

Application of Minilap assisted laparoscopic cholecystectomy with hidden incision in benign gallbladder diseases

Yuhong Liu1, Gang Deng1, Yang Chen2, Youwen Fan1, Zubing Chen1, Yaxin Jiang1, Di Tang1,()   

  1. 1. Department of General Surgery, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
    2. Department of Gastrointestinal and Hepatobiliary Surgery, Longhua District Central Hospital, Shenzhen 518000, China
  • Received:2022-03-31 Published:2022-06-10
  • Corresponding author: Di Tang
引用本文:

刘宇虹, 邓刚, 陈阳, 樊友文, 陈祖兵, 姜雅欣, 汤地. Minilap辅助隐疤痕腹腔镜胆囊切除术在胆囊良性疾病中的应用[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 304-308.

Yuhong Liu, Gang Deng, Yang Chen, Youwen Fan, Zubing Chen, Yaxin Jiang, Di Tang. Application of Minilap assisted laparoscopic cholecystectomy with hidden incision in benign gallbladder diseases[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(03): 304-308.

目的

探讨Minilap辅助隐疤痕腹腔镜胆囊切除术(LC)在胆囊良性疾病治疗中的优势与安全性。

方法

回顾性分析2020年3月至2021年3月在中山大学附属第七医院行LC的134例胆囊良性疾病患者临床资料。患者均签署知情同意书,符合医学伦理规定。其中男60例,女74例;年龄22~72岁,中位年龄45岁。根据术式分为两组:Minilap辅助组51例,行Minilap辅助隐疤痕LC;对照组83例,行常规三孔或四孔LC。观察两组围手术期情况。两组术后下床时间、术后进食时间等比较采用t检验。

结果

两组患者均手术顺利,围手术期未出现并发症。Minilap辅助组术后下床时间、术后进食时间分别为(3.0±1.5)、(7.3±3.2)h,明显短于对照组的(6.3±3.2)、(9.4±4.6)h(t=-6.966,-2.995;P<0.05);术后第一天疼痛评分、美容满意度评分分别为(1.2±0.9)、(2.7±1.1)分,亦明显低于对照组的(4.4±0.7)、(4.0±0.9)分(t=-22.910,-6.804;P<0.05)。

结论

与常规LC相比,Minilap辅助隐疤痕LC可减轻术后疼痛,加快术后康复,同时满足患者对美容的要求,且具有易操作性。

Objective

To evaluate the advantages and safety of Minilap assisted laparoscopic cholecystectomy (LC) with hidden incision in the treatment of benign gallbladder diseases.

Methods

Clinical data of 134 patients who underwent LC for benign gallbladder diseases in the Seventh Affiliated Hospital of Sun Yat-sen University from March 2020 to March 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 60 patients were male and 74 female, aged from 22 to 72 years, with a median age of 45 years. According to the surgical method, all patients were divided into the Minilap group (n=51) and control group (n=83). In the Minilap group, Minilap assisted LC with hidden incision was performed. In the control group, conventional 3- or 4-port LC was carried out. Perioperative conditions were observed between two groups. The time topostoperative off-bed activity and time of postoperative feeding between two groups were compared by t test.

Results

All patients in two groups successfully completed the surgery. No perioperative complications occurred. In the Minilap group, the time to postoperative off-bed activity and time of postoperative feeding were (3.0±1.5) and (7.3±3.2) h, significantly shorter than (6.3±3.2) and (9.4±4.6) h in the control group (t=-6.966, -2.995; P<0.05). In addition, the pain score at postoperative 1 d and the score of patient satisfaction with surgical incision were 1.2±0.9 and 2.7±1.1, significantly lower than 4.4±0.7 and 4.0±0.9 in the control group (t=-22.910, -6.804; P<0.05).

Conclusions

Compared with conventional LC, Minilap assisted LC with hidden incision can relieve postoperative pain, accelerate postoperative recovery. Besides, it meets the cosmetic requirements of patients, and it is convenient to operate.

图1 Minilap辅助隐疤痕LC术中
表1 Minilap辅助组和对照组腹腔镜胆囊切除术患者一般资料比较
表2 Minilap辅助组和对照组腹腔镜胆囊切除术患者围手术期情况比较(±s
[1]
Bueno Lledó J, Planells Roig M, Arnau Bertomeu C, et al. Outpatient laparoscopic cholecystectomy: a new gold standard for cholecystectomy[J]. Rev Esp Enferm Dig, 2006, 98(1):14-24.
[2]
李琦, 吴海滨. 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疗效比较[J]. 临床肝胆病杂志, 2017, 33(9):1758-1761.
[3]
高森, 张云峰, 王家文, 等. 经脐单孔腹腔镜与腹腔镜手术治疗胆囊良性疾病的疗效比较[J]. 肝胆外科杂志, 2021, 29(4):289-292.
[4]
李杉, 吴宏博, 吕辰艳, 等. 经胃自然腔道内镜手术行胆囊探查术的可行性及安全性研究[J]. 局解手术学杂志, 2020, 29(4):257-261.
[5]
刘允怡, 赖俊雄, 刘晓欣. 胆囊切除术技术及观念变迁给予我们的启示[J]. 中国实用外科杂志, 2015, 35(9): 917-919.
[6]
Wolfe BM, Gardiner B, Frey CF. Laparoscopic cholecystectomy:a remarkable development[J]. JAMA, 2015, 314(13):1406.
[7]
郑民华. 消化道微创手术:砥砺前行30年[J]. 中华消化外科杂志, 2022, 21(1):27-29.
[8]
Berlet M, Jell A, Bulian D, et al. Clinical value of alternative technologies to standard laparoscopic cholecystectomy-single port, reduced port, robotics, NOTES[J]. Chirurg, 2022, DOI: 10.1007/s00104-022-01608-9[Epub ahead of print].
[9]
Baekelandt J, De Mulder PA, Le Roy I, et al. Adnexectomy by vaginal natural orifice transluminal endoscopic surgery versus laparoscopy: results of a first randomised controlled trial (NOTABLE trial)[J]. BJOG, 2021, 128(11):1782-1791.
[10]
Mantke R, Diener M, Kropf S, et al. Single-incision multiport/single port laparoscopic abdominal surgery (SILAP): a prospective multicenter observational quality study[J]. JMIR Res Protoc, 2016, 5(3):e165.
[11]
Escobar-Dominguez JE, Garcia-Quintero P, Hernandez-Murcia C, et al. Outcomes in l aparoscopic cholecystectomy by single incision with SPIDER surgical system are comparable to conventional multiport technique: one surgeon's experience[J]. Surg Endosc, 2016, 30(11):4793-4799.
[12]
李坚, 袁伟, 张志勇, 等. 单孔腹腔镜胆囊切除术的临床应用研究[J]. 腹腔镜外科杂志, 2017, 22(11):832-834.
[13]
黄启荣, 杜波, 刘伟, 等. 经脐单孔腹腔镜胆囊切除术的技术改进与手术技巧[J]. 腹腔镜外科杂志, 2018, 23(5):367-370.
[14]
姚峰平, 柏文庆, 顾石, 等. 经脐单孔腹腔镜胆囊切除术22例[J]. 中国微创外科杂志, 2015, 15(5):470-471.
[15]
马锋, 锁瑞洋, 高乐, 等. 单孔腹腔镜的临床应用与研究进展[J].西安交通大学学报(医学版), 2021, 42(3):339-344.
[16]
黄琳娟, 代雪林, 唐均英, 等. "三位一体"认识和处理单孔腹腔镜的"筷子效应"[J]. 医学与哲学, 2018, 39(9):76-77,86.
[17]
张文正, 梁鲁, 姚碧辉. 单孔腹腔镜胆囊切除术的临床现状及隐忧[J]. 中国微创外科杂志, 2015, 15(4):366-367, 375.
[18]
Valcarenghi J, Hernigou J, Apicella G, et al. Long-term follow-up of the incisional hernia rate after single-incision laparoscopic cholecystectomy: a prospective observational study[J]. Acta Chir Belg, 2021, 121(5):320-326.
[19]
Raakow J, Klein D, Barutcu AG, et al. Safety and efficiency of single-incision laparoscopic cholecystectomy in obese patients:a case-matched comparative analysis[J]. J Laparoendosc Adv Surg Tech A, 2019, 29(8):1005-1010.
[20]
陈阳, 李东, 樊友文, 等. Minilap辅助两孔腹腔镜胆囊切除术10例分析[J/OL]. 中华肝脏外科手术学电子杂志, 2021, 10(4):414-417.
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