Objective To systematically review the effectiveness and safety of single-incision laparoscopic cholecystectomy (SILC) versus conventional multiport laparoscopic cholecystectomy (CMLC). Methods We electronically searched PubMed, EMbase, The Cochrane Library (Issue 1, 2013), CBM, CNKI, VIP and WanFang Data for randomized controlled trials (RCTs) on SILC versus CMLC from inception to January 1st, 2013. According to the Cochrane methods, the reviewers screened literature, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.2 software. Results Finally, 17 RCTs involving 1 233 patients were included. The results of meta-analysis showed that, compared with CMLC, SILC was lower in 24 h postoperative pain score (visual analogue scale, VAS) (SMD= –0.40, 95%CI –0.76 to –0.04, P=0.03), higher in cosmetic results score (SMD=1.56, 95%CI 0.70 to 2.43, P=0.000 4), and longer in operative time (MD=13.11, 95%CI 7.06 to 19.16, Plt;0.000 1). However, no significant difference was found in 6 h postoperative pain scores (VAS), postoperative complications, port-site hernia and hospital stay between the two groups. Conclusion SILC is a safe and effective technique for the treatment of uncomplicated benign gallbladder diseases, and it has certain advantages compared with CMLC, which is recommended in clinical application.
【摘要】 目的 评估罗哌卡因切口预注射联合曲马多对腹腔镜下胆囊切除术（laparoscopic cholecystectomy，LC）术后疼痛的影响。 方法 选取2010年6月-2011年4月行择期LC患者120例，年龄18~65岁，美国麻醉师协会Ⅰ~Ⅱ级，采用完全随机的设计分组：0.75%罗哌卡因10 mL切口注射+术毕静脉注射曲马多（2 mg/kg）组（A组，n=30）；生理盐水10 mL切口注射+术毕静脉注射曲马多（2 mg/kg）组（B组，n=30）；0.75%罗哌卡因10 mL切口注射+术毕静脉注射生理盐水10 mL组（C组，n=30）；生理盐水组（D组，n=30）。术后2、4、6、12、24 h分别评估右上腹部、右肩背部和腹壁切口疼痛进行视觉模拟评分（visual analog scale，VAS）。 结果 右上腹部及右肩背部疼痛VAS比较：与D组相比，A、B组VAS评分明显减少（Plt;0.05），而C组无明显统计学差异（Pgt;0.05）；B组与A组相比，2~24 h VAS评分明显增加（Plt;0.05）；C组与A组相比，2~24 h VAS评分增高（Plt;0.01）。腹壁切口疼痛VAS比较:与D组相比，A、B、C组VAS评分明显减少（Plt;0.05）；B组与A组相比，2~24 h VAS评分明显增加（Plt;0.05）；C组与A组相比，2~24 h VAS评分显著增高（Plt;0.01）。 结论 腹腔镜胆囊切除术术前切口罗哌卡因预注射-术毕曲马多静脉注射对减轻术后疼痛有良好效果。【Abstract】 Objective To evaluate the effects of preincisional ropivacaine plus tramadol intravenous injection on postoperative pain relief after laparoscopic cholecystectomy (LC). Methods One hundred and twenty patients aged between 18 and 65 years old with an ASA score from Ⅰ to Ⅱ who underwent elective laparoscopic cholecystectomy from June 2010 to April 2011 comprised this study. The patients were randomly divided into four groups with 30 in each group. Patients in group A had an infusion of 0.75% ropivacaine (10 mL) at the beginning of LC plus tramadol (2 mg/kg) intravenous injection at the end. Group B patients had an infusion of normal saline 0.9% (10 mL) at the beginning of LC plus tramadol (2 mg/kg) intravenous injection at the end. Patients in group C had an infusion of 0.75% ropivacaine (10 mL) at the beginning of LC plus normal saline 0.9% (10 mL) intravenous injection at the end. Group D (control group) patients had neither ropivacaine nor tramadol infusion. Pain in the right upper abdomen, right shoulder tip and abdominal incision were assessed at hour 2, 4, 6, 12, and 24 postoperatively using a visual analog score (VAS). Results Right upper abdomen and right shoulder tip pain VAS comparison: significantly lower pain scores were observed in group A and B (Plt;0.05) than in group D (Pgt;0.05). Group A had significantly lower pain scores than group B (Plt;0.05) and C (Plt;0.01) at postoperative hours 2, 4, 6, 12, and 24. Abdominal incision pain VAS comparison: VAS scores were significantly lower in group A, B and C than in group D (Plt;0.05). Group A had significantly lower pain scores than group B (Plt;0.05) and C (Plt;0.01) at postoperative hours 2, 4, 6, 12, and 24. Conclusion Preincisional ropivacaine at the beginning of LC combined with tramadol intravenous injection at the end can effectively alleviate postoperative pain after laparoscopic cholecystectomy.
【摘要】 目的 总结腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）治疗结石嵌顿性急性胆囊炎的疗效。 方法 2001年8月-2009年11月，采用LC治疗187例结石嵌顿性急性胆囊炎。 结果 179例顺利完成 L C手术；8例术中改为开腹手术。其中3例术后发生胆瘘，均经乳胶管引流胆汁，7～14 d后拔管；其余患者均痊愈出院。 结论 LC治疗结石嵌顿性急性胆囊炎安全可行，但应遵循个体化原则，熟练镜下操作技巧及正确处理方法是获得满意疗效关键。
【摘要】 目的 探讨经脐单孔腹腔镜胆囊切除术的临床可行性及其优缺点。 方法 回顾分析2010年7-9月行经脐单孔腹腔镜胆囊切除术34例患者临床资料。 结果 患者均顺利完成单孔腹腔镜胆囊切除术，手术平均时间为65 min，术后平均住院时间为3 d，术后未发生出血、感染、胆瘘等并发症。 结论 单孔腹腔镜胆囊切除术是安全可行的，术后腹部无明显瘢痕，美容效果明显。【Abstract】 Objective To evaluate the feasibility and value of the trans-umbilical single-port laparoscopic cholecystectomy. Methods The clinical data of 34 patients who underwent trans-umbilical single-port laparoscopic cholecystectomy from July to September 2010 were retrospectively analyzed. Results The operations of 34 patients were successfully performed. The mean operative duration was 65 minutes, and the mean duration in hospital after the operation was 3 days. No infection, postoperative bleeding, and biliary leakage occurred postoperatively. Conclusion Trans-umbilical single-port laparoscopic cholecystectomy is safe and feasible with good cosmetic effect.
目的:探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）致胆管损伤的原因、预防措施和经验教训。方法:分析2007年8月～2008年8月期间我院胆道外科收治的3例胆管严重损伤病例资料。结果:3例LC术致胆管严重损伤的患者均发生肝门部胆管狭窄，并均在肝门胆管成形后行胆管空肠Roux-en-Y吻合术，吻合口直径2.0～3.0 cm。术后患者恢复良好，均顺利出院，住院时间为10～15天。随访1～6个月，1例于术后2月出现肝区隐痛，口服消炎药可控制，其余未见异常不适。结论:术中仔细辩清肝总管、胆总管与胆囊管的三者关系是预防LC术胆管损伤的关键。胆管空肠Roux-en-Y吻合术是处理胆管损伤的重要手术方式。LC术时，胆道外科医生思想上要高度重视，不可盲目追求速度。
ObjectiveTo compare the advantages and disadvantages of transumbilical single port (TUSP) and conventional laparoscopic cholecystectomy (LC). MethodsThe clinical data of 45 patients underwent elective LC were analyzed, 20 patients with TUSP LC (TUSP-LC group), 25 patients with conventional LC (conventional LC group). The operation time, Child-Pugh score and painkiller application frequency within three days after operation, the first time of out of bed and hospital stay after operation, intraoperative blood loss, chronic pain within one month after surgery were compared between two groups. ResultsAll cases were operated successfully except one patient in the conventional LC group. The frequency of painkiller application within three days after operation and postoperative hospital stay in the TUSP-LC group were better than those in the conventional LC group (Plt;0.05). There were no significant differences on postoperative chronic pain of surgical area within 1 month and Child-Pugh score between two groups (Pgt;0.05). The operation time and intraoperative blood loss in the conventional LC group were less than those in the TUSP-LC group (Plt;0.05, Plt;0.01). ConclusionTUSP LC has the advantages of small wound, slight pain, and fast recovery.
目的探讨经脐单孔腹腔镜胆囊切除术（LC）的临床应用。方法分析我院2009年1月至2010年5月期间120例因结石性胆囊炎和胆囊息肉行经脐单孔LC患者的临床资料。结果98例患者手术成功，手术时间38～126 min，平均50.3 min。22例单孔手术失败改成两孔完成手术。住院时间2～4 d，平均2.5 d。全组患者无出血及漏胆并发症发生，仅2例（1.7%）脐部戳孔处术后轻度感染，经局部换药治疗2周愈合。89例（90.8%）采用单孔法患者获得1～15个月（平均7.3个月）随访，均无并发症发生。结论单孔LC安全可行，但使用现有腹腔镜设备操作难度较大，器械及技术尚需进一步完善。
目的总结胆囊切除术致医源性胆管损伤的原因、诊断、治疗及预防的经验。方法回顾性分析昆明市第一人民医院2006年5月至2011年5月期间经治的17例胆囊切除术致医源性胆管损伤患者的临床资料。结果损伤部位包括隆突2例，肝总管3例，胆囊管汇入胆总管部7例，胆总管4例，副肝管1例。1例一期术中端端吻合，2例一期吻合并留置T管支撑，1例行胆囊管结扎，2例内镜下留置鼻胆管引流，4例术后内镜下留置胆管支架，6例术后行胆肠Roux-en-Y吻合，1例行脱细胞基质材料修补。随访0.3～5年，平均2.3年，效果良好16例，1例反复发生胆管炎。结论医源性胆管损伤重在预防，精细解剖胆囊三角、严格遵循“确认-剪断-确认”三步骤是防止医源性胆管损伤的关键; 及时发现和正确的处理方法是降低其死亡率及改善预后的关键。
目的 总结肝硬变状态下腹腔镜胆囊切除术（LC）治疗胆囊疾病的经验。方法 回顾性分析30例肝硬变合并胆囊疾病患者行LC的临床资料。结果 30例患者中肝功能Child-Pugh A级8例，B级11例，C级11例。LC术后6例(20.0%)发生并发症，其中Child-Pugh B级2例,C级4例。治愈29例（96.7%）； 死亡1例(3.3%)，死亡者为Child-Pugh C级。结论 存在肝硬变时,肝功能Child-Pugh A及B级者行LC比较安全,C级风险较大,应列为手术禁忌。