Objective To explore the feasibility， operation method， and clinical application value of transumbilical single-port laparoscopic cholecystectomy （TUSP-LC） in treatment for children patients with benign gallbladder diseases. Methods The clinical data of 64 patients with benign gallbladder diseases from June 2009 to June 2011 were analyzed retrospectively. The patients were divided into TUSP-LC group （n=41） and convention three-port LC （CTP-LC group， n=23）. The operative time， intraoperative blood loss， conversion to CTP-LC or laparotomy， operative complications， and hospital stay were recorded. The pains were registered at 3，6，12，24，48， and 72h postoperatively using visual analog scale （VAS）. The patients were given satisfaction questionnaires with surgery at 6 time points （1 week， 2 weeks， 1 month， 3 months， 6 months， 12 months） during a 12 months follow-up. Results A total of 64 pediatric LCs were performed successfully， no patients were converted to laparotomy. Except for one case of incision infection in the CTP-LC group 〔4.35%（1/23）〕 and one case of incision infection and one case of ecchymoma in the TUSP-LC group 〔4.88% （2/41）〕， no other complications such as bile duct injury， bile leakage， and incision hernia happened， the total complication rate was not significant difference in two groups （P＞0.05）. The operative time 〔（47.54±18.71） min versus（45.33±10.58） min〕， intraoperative blood loss 〔（18.56±13.34） ml versus （17.28±12.53） ml〕， and hospital stay 〔（1.67±0.36） d versus （1.81±0.38） d〕were not significant differences in two groups （P＞0.05）. The VAS score was not statisticly significant within 24h in two groups （P＞0.05）， but which in the TUSP-LC group was significantly lower than that in the CTP-LC group after 24h postoperatively （P＜0.05）. During a 12 months follow-up， the score of satisfaction in the TUSP-LC group was significantly higher than that in the CTP-LC group （P＜0.05）. Conclusions TUSP-LC is a safe and feasible method in the children patients with benign gallbladder diseases. It can be performed with the same technical exposure and outcomes as multi-port laparoscopy， with the added benefit of relieving postoperative pain and little no scarring.
目的探討腹腔鏡下不同的入肝血流阻斷方法下行規則性或不規則性局部肝切除的手術方法及其臨床應用。 方法回顧性分析2007年5月至2012年7月期間在江蘇省蘇北人民醫院完成的25例腹腔鏡肝切除術患者的臨床資料，其中行規則性肝切除術14例，不規則性局部肝切除術11例。術后病理學檢查證實原發性肝癌9例，肝血管瘤10例，結直腸癌肝轉移1例，左肝內膽管結石5例。 結果本組25例均成功完成了腹腔鏡肝切除術（其中合并膽囊切除術3例，合并膽囊切除及膽總管探查術1例），無中轉開腹手術者。其中行區域性入肝血流阻斷聯合規則性肝切除術14例，應用自制的第一肝門阻斷器行全肝入肝血流阻斷聯合不規則的局部肝切除術11例。手術時間（149.6±19.8）min（120～195 min），術中出血量（320±73.6）mL（180～460 mL），腹腔引流管放置時間3～11 d。有1例術后第3天出現膽汁漏，予以放置自制雙套管沖洗后引流量逐漸減少，術后第11天順利拔管；其余病例未發生膽汁漏、出血、感染等并發癥。術后住院時間（8.6±2.4）d（5～13 d）。9例肝臟惡性腫瘤患者術后均獲隨訪，截至2012年7月29日，其隨訪時間12～48個月，平均17個月，1年無瘤生存患者有7例。 結論腹腔鏡肝切除術是安全可行的，肝臟血流阻斷技術是其成功的關鍵和保障。左半肝或左外葉病灶可考慮行區域性入肝血流阻斷聯合規則性肝切除術；右半肝不規則的病灶或病灶較小時，應用自制的第一肝門阻斷器行全肝入肝血流阻斷聯合不規則的局部肝切除術，是簡潔、實用的方法，可避免切除過多的肝組織。