设计、开发和评估一种新型的腹腔镜胆囊切除术中胆囊提取退缩装置。
Design, development, and evaluation of a novel retraction device for gallbladder extraction during laparoscopic cholecystectomy.
机构信息
Department of Surgery, University of Virginia, P.O. Box 800759, Charlottesville, 22908, VA, USA.
出版信息
J Gastrointest Surg. 2014 Feb;18(2):334-9. doi: 10.1007/s11605-013-2292-4. Epub 2013 Jul 30.
BACKGROUND
A source of frustration during laparoscopic cholecystectomy involves extraction of the gallbladder through port sites smaller than the gallbladder itself. We describe the development and testing of a novel device for the safe, minimal enlargement of laparoscopic port sites to extract large, stone-filled gallbladders from the abdomen.
METHODS
The study device consists of a handle with a retraction tongue to shield the specimen and a guide for a scalpel to incise the fascia within the incision. Patients enrolled underwent laparoscopic cholecystectomy. Gallbladder extraction was attempted. If standard measures failed, the device was implemented. Extraction time and device utility scores were recorded for each patient. Patients returned 3-4 weeks postoperatively for assessment of pain level, cosmetic effect, and presence of infectious complications.
RESULTS
Twenty (51 %) of 39 patients required the device. Average extraction time for the first eight patients was 120 s. After interim analysis, an improved device was used in 12 patients and average extraction time was 24 s. There were no adverse events. Postoperative pain ratings and incision cosmesis were comparable between patients with and without use of the device.
CONCLUSION
The study device enables safe and rapid extraction of impacted gallbladders through the abdominal wall.
背景
在腹腔镜胆囊切除术过程中，通过比胆囊本身小的端口取出胆囊是一个令人沮丧的问题。我们描述了一种新型装置的开发和测试，该装置可安全、微创地扩大腹腔镜端口，以从腹部取出充满结石的大型胆囊。
方法
研究装置由一个带有缩回舌的手柄组成，用于保护标本，以及一个用于手术刀切开切口内筋膜的导向器。入组的患者接受腹腔镜胆囊切除术。尝试进行胆囊取出术。如果标准措施失败，则使用该装置。记录每位患者的提取时间和设备使用评分。患者在术后 3-4 周返回，评估疼痛程度、美容效果和感染并发症的发生情况。
结果
39 例患者中有 20 例（51%）需要使用该装置。前 8 例患者的平均提取时间为 120 秒。中期分析后，在 12 例患者中使用了改进后的装置，平均提取时间为 24 秒。没有不良事件发生。使用和不使用该装置的患者术后疼痛评分和切口美容效果相当。
结论
该研究装置可安全、快速地通过腹壁提取嵌顿的胆囊。
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