Dallemagne B, Perretta S, Allemann P, Asakuma M, Marescaux J
Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.
Br J Surg. 2009 Oct;96(10):1162-6. doi: 10.1002/bjs.6704.
Clinical application of natural orifice transluminal endoscopic surgery is under investigation. Preliminary results of transvaginal cholecystectomy in women and associated technical issues have been described. The technique and initial results of hybrid transgastric cholecystectomy are now reported.
Five patients aged 18-60 years with uncomplicated cholelithiasis underwent transgastric cholecystectomy in a prospective intention-to-treat study that included the option of transparietal assistance (hybrid technique) if needed. The gastrotomy was created under laparoscopic guidance through a 5-mm umbilical trocar, which also served to expose the gallbladder, clip the cystic pedicle and close the gastrotomy. Cholecystectomy was carried out using flexible instruments through the endoscope, alone or in combination with laparoscopic instruments.
The procedure was successful in all patients with a median operating time of 150 (range 120-180) min. Transparietal assistance was necessary in all patients. There were no intraoperative or postoperative complications.
Until technical issues have been resolved, a hybrid procedure with liberal use of transparietal assistance is the safest and most efficient approach for transgastric cholecystectomy. Further studies are essential to evaluate the role of this new approach.
经自然腔道内镜手术的临床应用正在研究中。已报道了女性经阴道胆囊切除术的初步结果及相关技术问题。现报告经胃胆囊切除术的技术及初步结果。
在一项前瞻性意向性治疗研究中，对5例年龄在18 - 60岁、患有单纯性胆结石的患者实施经胃胆囊切除术，必要时可选择经腹辅助（混合技术）。在腹腔镜引导下，通过一个5毫米的脐部套管针建立胃切开术，该套管针还用于暴露胆囊、夹闭胆囊蒂及关闭胃切开术。使用柔性器械经内镜单独或联合腹腔镜器械进行胆囊切除术。
所有患者手术均成功，中位手术时间为150（120 - 180）分钟。所有患者均需要经腹辅助。无术中或术后并发症。
在技术问题解决之前，大量使用经腹辅助的混合手术是经胃胆囊切除术最安全、最有效的方法。进一步研究对于评估这种新方法的作用至关重要。
