探讨经脐入路三通道腹腔镜胆囊切除术（LC）的安全性与疗效。

回顾性分析2007年11月至2025年5月于上海中医药大学附属曙光医院松江分院接受经脐入路三通道LC的10 000例胆囊良性疾病患者的临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男3 786例，女6 214例；年龄18~94岁，中位年龄65岁；择期手术9 160例，急诊手术840例。所有手术均使用常规腹腔镜器械，解剖困难者于剑突下追加一5 mm辅助操作孔。统计手术时间、术中出血量、术后疼痛数字评分量表（NRS）评分及并发症发生情况。男女患者手术时间、术中出血量、术后NRS评分比较采用t检验。绘制手术学习曲线分析学习进程的量化关系。

所有患者均顺利完成手术。男性患者手术时间为（25±11） min，术中出血量（15±5） ml，术后NRS评分（1.17±0.12）分；女性患者手术时间为（26±11） min，术中出血量（15±5） ml，术后NRS评分（1.17±0.10）分，男女患者上述指标比较差异无统计学意义（t=-1.371，0.946，-0.001；P>0.05）。术后住院时间2.0~4.0 d，中位时间3.2 d。共发生并发症43例，其中术中胆管损伤3例，均行腹腔镜下修补术；胆总管横断伤中转开腹行胆总管端端吻合1例，肝总管横断伤中转开腹行胆肠吻合1例，术中大出血中转开腹止血1例；术后腹腔出血4例、胆漏2例均行非计划再次腹腔镜手术；切口疝3例后期手术修补；术后胆总管结石3例行ERCP治疗；术后胆漏12例、切口感染10例，经保守治疗痊愈；无死亡病例。术后随访2~60个月，手术瘢痕隐蔽，美容效果良好。学习曲线分析显示，约100例的系统训练是实现技术成熟的关键。

经脐入路三通道LC适用于择期及急诊手术，安全可行且美容效果佳，但需在保证患者安全及术野清晰的前提下开展，避免盲目应用。约100例的系统训练是实现技术成熟的关键。

To evaluate the safety and efficacy of three-port laparoscopic cholecystectomy (LC) via the umbilical approach.

Clinical data of 10 000 patients with benign gallbladder diseases who received three-port LC via the umbilical approach in Songjiang Branch of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from November 2007 to May 2025 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 3 786 patients were male and 6 214 were female, aged from 18 to 94 years, with a median age of 65 years. 9 160 patients underwent elective surgery and 840 received emergency surgery. Conventional laparoscopic instruments were used in all cases. A 5-mm auxiliary port was created under the xiphoid process for those with anatomical difficulties. The operation time, intraoperative blood loss, postoperative pain intensity assessed by numerical rating scale (NRS) score and postoperative complications were recorded. The operation time, intraoperative blood loss and postoperative NRS score between male and female patients were compared by t-test. The surgical learning curve was delineated to analyze the quantitative relationship of learning process.

All patients successfully completed LC. In male patients, the operation time was (25±11) min, intraoperative blood loss was (15±5) ml, and postoperative NRS score was (1.17±0.12). In female counterparts, the operation time was (26±11) min, intraoperative blood loss was (15±5) ml, and postoperative NRS score was (1.17±0.10). No significant differences were noted between male and female patients (t=-1.371, 0.946, -0.001; all P>0.05). The length of postoperative hospital stay was (2.0-4.0) d, with a median of 3.2 d. 43 patients developed postoperative complications. 3 cases experienced intraoperative bile duct injury, which were repaired by laparoscopy. 1 case of cross-sectional injury of common bile duct was converted to open surgery for end-to-end anastomosis of common bile duct. 1 case of cross-sectional injury of common hepatic duct was converted to open cholangioenterostomy. 1 case of massive hemorrhage was converted to open surgery for hemostasis. 4 cases of postoperative abdominal bleeding and 2 cases of postoperative bile leakage underwent unplanned laparoscopic surgery. 3 cases of incisional hernia received surgical repair. 3 cases of postoperative choledocholithiasis were treated by ERCP. 12 cases of bile leakage and 10 cases of incisional infection were cured by conservative treatment. No death was reported. Follow-up ranged from 2 to 60 months. The scars were hidden and the cosmetic effect was favorable. The learning curve showed that systematic training of approximately 100 cases was the key to realize technical maturity.

Three-port LC via the umbilical approach is suitable for elective and emergency surgeries, which is safe, feasible and yields favorable cosmetic effect. However, it should be carried out on the premise of ensuring the safety of patients and clear surgical field. Systematic training of approximately 100 cases was the key to realize technical maturity.