[摘要] 目的 探讨常规器械经脐单孔两通道腹腔镜胆囊切除术的临床疗效及应用价值。方法 回顾性分析2010年9月—2017年3月该院普外科開展的常规器械经脐单孔两通道腹腔镜胆囊切除术380例的临床资料。结果371例成功实现了常规器械经脐单孔两通道腹腔镜胆囊切除术，成功率达97.63%。6例改为两孔法，3例改为三孔法。平均手术时间51 min；术后疼痛评分平均2.5分，平均住院时间4.6 d ，无腹腔内出血、胆漏、黄疸、切口感染等并发症的发生，术后仅脐部隐蔽的微小疤痕，美容效果明显。术后随访3个月、6个月及1年，均无腹痛、黄疸、穿刺孔疝等。 结论 常规器械经脐单孔两通道腹腔镜胆囊切除术是即经济实惠，又安全可行的，具有更加美观、微创，疼痛轻，住院时间短，恢复快等优点，符合患者心理需求，适合在我国基层医院推广。

 [关键词] 经脐单孔腹腔镜；胆囊切除术；常规器械

 [中图分类号] R657.4 [文献标识码] A [文章编号] 1674-0742(2017)11(b)-0039-04

 [Abstract] Objective This paper tries to discuss about the clinical efficacy and the value of application in transumbilical single-port double trocars laparoscopic cholecystectomy using conventional laparoscopical instruments. Methods The clinical data of 380 patients who underwent transumbilical single-port double trocars laparoscopical cholecystectomy from September 2001 to March 2017 were retrospectively analyzed. Conventional laparoscopical instruments were used in all the surgeries. Results Surgical procedures were performed successfully in 371 cases and the success rate was 97.63%. 6 cases were converted to double-port procedures， and 3 cases were converted to three-port procedures. The average time of surgery was 51 minutes， mean visual analgesic scores (VAS) was 2.5 points； average hospital stay was 4.6 days. No postoperative complications such as abdomen bleeding， bile leakage， jaundice or incisional infection occurred. Umbilical incision was small and microscopic. No abdomen pain， jaundice and incisional hernia occurred after three， six， and twelve months of follow-up. Conclusion Transumbilical single-port double trocars laparosopic cholecystectomy using conventional laparoscopical instruments is an economical， safe and reliable approach， and it has many advantages such as： better cosmetic results， fewer invasive procedures， lesser pain， shorter hospitalization and earlier return to daily activities， which can meet the patient’s psychological needs， therefore it is worthy of application in the primary hospitals in China.

 [Key words] Transumbilicus single-port laparoscopic； Cholecystectomy； Conventional instruments

 腹腔镜胆囊切除早已成为胆囊切除的“金标准”[1]， 传统的腹腔镜胆囊切除术要在腹壁做3～4个穿刺孔，愈合后仍会留下多个手术瘢痕，随着腹腔镜手术技术的不断熟练与完善及手术器械的不断改进与更新，经脐单孔腹腔镜技术应运而生并取得迅速发展。国内首例经脐单孔腹腔镜胆囊切除术是2008年朱江帆等[2]完成的，目前该技术在各大医院逐渐展开，但大多数医院应用专用单孔器械，价格昂贵，使用次数有限，在基层医院推广起来比较困难。该院于2010年9月—2017年3月使用常规腹腔镜器械外加一个国产康基的可弯曲分离钳开展了经脐单孔两通道腹腔镜胆囊切除术380例，使微创与美观完美结合，值得基层医院临床推广，现报道如下。

 1 资料与方法

 1.1 一般资料

 该组380例，男149例，女231例。年龄16～60岁，平均48岁。慢性结石性胆囊炎297例，胆囊息肉样病变58例，两者并存者13例，慢性结石性胆囊炎急性发作者12例，合并慢性阑尾炎12例，高血压病37例，糖尿病20例。所有病例术后均经病理学检查证实。均严格把握手术适应证。病例选择标准：①胆囊良性病变。②近期1个月内无严重胆道炎症发作史，既往发作不频繁，胆囊周围炎症轻、壁厚, 百拇医药(马军礼 程斌 高宏 崔东明 肖光辉 欧阳国庆 张永祥) 第 1 2 3 页 下一页
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