Kim Say-June, Kim Kee-Hwan, An Chang-Hyeok, Kim Jeong-Soo
Say-June Kim, Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon 301-723, South Korea.
World J Gastroenterol. 2015 Dec 7;21(45):12857-64. doi: 10.3748/wjg.v21.i45.12857.
AIM: To investigate the safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration (nSIL-CBDE) by comparing the surgical outcomes of this technique with those of conventional laparoscopic CBDE (CL-CBDE). METHODS: We retrospectively analyzed the clinical data of patients who underwent CL-CBDE or nSIL-CBDE for the treatment of common bile duct (CBD) stones between January 2000 and December 2014. For performing nSIL-CBDE, a needlescopic grasper was also inserted through a direct puncture below the right subcostal line after introducing a single-port through the umbilicus. The needlescopic grasper helped obtain the critical view of safety by retracting the gallbladder laterally and by preventing crossing or conflict between laparoscopic instruments. The gallbladder was then partially dissected from the liver bed and used for retraction. CBD stones were usually extracted through a longitudinal supraduodenal choledochotomy, mostly using flushing a copious amount of normal saline through a ureteral catheter. Afterward, for the certification of CBD clearance, CBDE was performed mostly using a flexible choledochoscope. The choledochotomy site was primarily closed without using a T-tube, and simultaneous cholecystectomies were performed. RESULTS: During the study period, 40 patients underwent laparoscopic CBDE. Of these patients, 20 underwent CL-CBDE and 20 underwent nSIL-CBDE. The operative time for nSIL-CBDE was significantly longer than that for CL-CBDE (238 ± 76 min vs 192 ± 39 min, P = 0.007). The stone clearance rate was 100% (40/40) in both groups. Postoperatively, the nSIL-CBDE group required less intravenous analgesic (pethidine) (46.5 ± 63.5 mg/kg vs 92.5 ± 120.1 mg/kg, P = 0.010) and had a shorter hospital stay than the CL-CBDE group (3.8 ± 2.0 d vs 5.1 ± 1.7 d, P = 0.010). There was no significant difference in the incidence of postoperative complications between the two groups. CONCLUSION: The results of this study suggest that nSIL-CBDE could be safe and feasible while improving cosmetic outcomes when performed by surgeons trained in conventional laparoscopic techniques.
目的：通过比较针状内镜抓钳辅助单孔腹腔镜胆总管探查术（nSIL-CBDE）与传统腹腔镜胆总管探查术（CL-CBDE）的手术结果，探讨其安全性和可行性。 方法：回顾性分析2000年1月至2014年12月期间接受CL-CBDE或nSIL-CBDE治疗胆总管结石患者的临床资料。进行nSIL-CBDE时，在经脐部置入单孔通道后，通过右肋缘下直接穿刺再插入针状内镜抓钳。针状内镜抓钳通过将胆囊向外侧牵拉以及防止腹腔镜器械交叉或冲突来帮助获得关键的安全视野。然后将胆囊从肝床部分游离并用于牵拉。胆总管结石通常通过十二指肠上段胆总管纵行切开取出，大多是通过输尿管导管冲洗大量生理盐水。之后，为证实胆总管通畅，大多使用可弯曲胆总管镜进行胆总管探查。胆总管切开部位主要不放置T管直接缝合，并同期行胆囊切除术。 结果：研究期间，40例患者接受了腹腔镜胆总管探查术。其中，20例行CL-CBDE，20例行nSIL-CBDE。nSIL-CBDE的手术时间显著长于CL-CBDE（238±76分钟对192±39分钟，P = 0.007）。两组的结石清除率均为100%（40/40）。术后，nSIL-CBDE组所需静脉镇痛剂（哌替啶）较少（46.5±63.5毫克/千克对92.5±120.1毫克/千克，P = 0.010），住院时间比CL-CBDE组短（3.8±2.0天对5.1±1.7天，P = 0.010）。两组术后并发症发生率无显著差异。 结论：本研究结果表明，对于接受传统腹腔镜技术培训的外科医生而言，nSIL-CBDE在改善美容效果的同时可能是安全可行的。
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