改良经脐入路腹腔镜胆囊切除术

目的探讨经脐入路腹腔镜胆囊切除术（LC）的可行性。方法回顾性分析2010年7月至12月21例行经脐入路LC（经脐组）与44例行传统LC（传统组）患者的临床资料,并且对两组手术时间、术后总住院天数以及术前和术后第1天WBC、C-反应蛋白（CRP）、ALT、AST、血清总胆红素（STB）、结合胆红素（CB）、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（γ-GT）的检测值进行比较。结果经脐组平均手术时间（51.29±5.56）min,术后平均总住院天数（2.6±0.5）d。传统组平均手术时间（9.25±2.69）min,术后平均总住院天数（3.1±0.6）d。经脐组术后第1天CRP、ALT、AST与术前平均差值分别为（5.37±4.05）mg/L、（7.29±6.58）IU/L、（13.29±8.50）IU/L,传统组术后第1天CRP、ALT、AST与术前平均差值分别为（10.12±6.29）mg/L、（26.90±16.01）IU/L、（29.05±15.47）IU/L,两者间的差异有统计学意义（P〈0.05）。结论改良后的经脐入路LC在技术上是可行的,与传统LC相比,虽然技术难度大、手术时间长,但炎症反应及肝功能方面对机体的影响轻,并且达到更加微创、术后恢复更快、住院天数更短及腹壁无可见瘢痕的美容效果。

Improved transumbilical laparoscopic cholecystectomy

Objective To investigate the feasibility of transumbilical laparoscopic cholecystectomy（LC）.Methods Retrospective analysised the clinical data of 21 patients suffered transumbilical LC and 44 petients suffered traditional LC from July 2010 to December,then compared the operation time,total length of hospital stay after surgery,preoperative and the first postoperative day test values of WBC,C-reactive protein（CRP）,ALT,AST,serum total bilirubin（STB）,conjugated bilirubin（CB）,alkaline phosphatase（ALP）,γ-Glutamyl transpeptidase（γ-GT）.Results The average time of operation of transumbilical LC were（51.29 ± 5.56） minutes,and the average days of total hospital stay after surgery were（2.6 ± 0.5） days.But The average time of operation of the traditional LC were（9.25 ± 2.69） minutes,and the average days of total hospital stay after surgery were（3.1 ± 0.6） days.The mean difference of preoperative and the first postoperative day for transumbilical LC on CRP、ALT、AST was（5.37 ± 4.05） mg/L 、（7.29 ± 6.58） IU/L 、（13.29 ± 8.50） IU/L respectively.On the contrary,the mean difference of preoperative and the first postoperative day for the traditional LC on CRP 、 ALT 、 AST was（10.12 ± 6.29） mg/L 、（26.9 ± 16.01） IU/L 、（29.05 ± 15.47） IU/L respectively.Conclusions The improved transumbilical LC is technically feasible.Compared with the traditional LC,transumbilical LC is technically difficult and time-consuming,but it is lighter in the inflammatory response and liver function effects on the body,and achieve a more invasive,quicker postoperative recovery,shorter hospital stay and the abdominal wall with no visible scar cosmetic effect.