Suo Guangjun, Xu Anan
Department of Digestive Surgery, East Hospital, Tongji University School of Medicine , Shanghai, People's Republic of China .
J Laparoendosc Adv Surg Tech A. 2013 Oct;23(10):849-54. doi: 10.1089/lap.2012.0561. Epub 2013 Aug 27.
Low conversion rate, high safety, and good cosmetic result with less medical cost are chased by all laparoscopic surgeons. We used general laparoscopic instruments and combined with absorbable thread trying to perform a clipless minilaparoscopic cholecystectomy for benign gallbladder patients and got all the above-mentioned results.
From January 2008 to February 2011, 1096 minilaparoscopic cholecystectomies were performed for patients with uncomplicated or complicated benign gallbladder disease by our treatment team. The three-port technique with the help of an electrocautery hook, forceps, and suction was applied for laparoscopy cholecystectomy, and the cystic duct and vessels were ligated by absorbable thread rather than hemostasis clips and Harmonic(®) scalpels (Ethicon, Cincinnati, OH). The operative time, blood loss, subhepatic drain, conversion rate, drainage time, and hospital stay were reviewed and statistically analyzed.
Our conversion rate was 0.18%, which was much lower than those reported by many studies. The mean operating time was 28 minutes (range, 11-70 minutes). Mean blood loss was 12 mL (range, 5-200 mL). A subhepatic drain was placed in 63 patients, with a mean drainage time of 1.7 days (range, 1-6 days). The mean postoperative hospital stay was 2.5 days (range, 2-7 days). No postoperative bleeding, biliary leakage, intraabdominal infection, umbilical site infection, umbilical incision herniation, biliary duct or bowel injury, or mortality occurred.
Minilaparoscopic cholecystectomy using absorbable thread instead of clips and Harmonic scalpels offers a safe, effective, and economical surgical alternative for benign gallbladder patients.
低转化率、高安全性、良好的美容效果以及较低的医疗成本是所有腹腔镜外科医生所追求的。我们使用普通腹腔镜器械并结合可吸收线，试图为良性胆囊疾病患者实施无夹微型腹腔镜胆囊切除术，并取得了上述所有结果。
2008年1月至2011年2月，我们的治疗团队为患有单纯性或复杂性良性胆囊疾病的患者实施了1096例微型腹腔镜胆囊切除术。借助电灼钩、镊子和吸引器采用三孔技术进行腹腔镜胆囊切除术，胆囊管和血管用可吸收线结扎，而非使用止血夹和超声刀（爱惜康公司，俄亥俄州辛辛那提）。回顾并统计分析手术时间、失血量、肝下引流、转化率、引流时间和住院时间。
我们的转化率为0.18%，远低于许多研究报道的转化率。平均手术时间为28分钟（范围为11 - 70分钟）。平均失血量为12毫升（范围为5 - 200毫升）。63例患者放置了肝下引流管，平均引流时间为1.7天（范围为1 - 6天）。术后平均住院时间为2.5天（范围为2 - 7天）。未发生术后出血、胆漏、腹腔感染、脐部感染、脐部切口疝、胆管或肠道损伤或死亡。
使用可吸收线而非夹子和超声刀的微型腹腔镜胆囊切除术为良性胆囊疾病患者提供了一种安全、有效且经济的手术选择。
