胆囊底缝线牵引二孔免夹法腹腔镜胆囊切除术

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1、医学杂志2012年5月第34卷第5期NingxiaMedJ,May2012Vo34．No．5·40l·文章编号：1001—5949(2012)05—0401一O3·论著·胆囊底缝线牵引二孑L免夹法腹腔镜胆囊切除术田明国，杨立玲’，杨勇，关洪坤，尚凡晶，钱益，胡丹，李智勇，张敏[摘要]目的探讨腹腔镜胆囊切除术的新方法。方法经脐窝上缘弧形切开皮肤1．8～2．5cm，完成气腹后靠近切口左角插入鞘管及腹腔镜，紧贴切口右角插入无损伤钳。将穿刺带线针经剑突下皮肤切口刺入腹腔并穿过胆囊底部浆肌层，经剑突下切口插入5mm鞘管和操作钳，将胆囊底缝线打结成一线环。于右锁骨中线肋缘下刺人多功能拨棒，套住胆囊底部线

2、环向肝脏膈面顶起，使胆囊充分显露。丝线结扎胆囊动脉和胆囊管，自胆囊底部剥离胆囊，胆囊标本经脐孔取出。结果110例胆囊结石并胆囊炎患者采用该法治疗，97例(88．2％)获得成功。手术时间35—66min，平均44min；胆囊牵引所需时间3～7min，平均4．2min。另13例(11．8％)因分离困难而改为三孔法。全部患者术后无胆瘘、出血等并发症发生。结论该法术中显露满意，操作如同四孔法一样方便，因此，是一种更加微创、实用的腹腔镜胆囊切除术式。[关键词]二孔法；腹腔镜胆囊切除术；缝线牵引；线扎法；免夹法[中图分类号]R657．4[文献标识码]ATwo—portcliplesslaparoscop

3、iccholecystectomyusingthreadretractionofthegallbladderfundusTIANMing—guo，eta1．DepartmentofHepatobiliarySurgery，NingxiaPeople&Hospital，Yinchuan750021，China[Abstract]0bjectiveToexploreanewmethodforlaparoscopiccholecystectomy．MethodsAnarcincisionof2．5cmwasmadebelowtheupperedgeoftheumbilicus．Afterinfla

4、tion，the10mmtrocarwasinsertedattheleftsideoftheincisionandaforcepsin—sertedatthefight．Thegallbladderfunduswasliftedbytheforcepsandsewedbyalongneedlewithasetofsilksutureonthetip．Afterwithdrawingtheneedle，a5mmtrocarwasinsertedandthesilksutureleftinthegallbladderfunduswastiedtoformaloop．Apuncturingsti

5、ckwasinsertedatthemidclavicularlineunderrightcostalmargin．Thesutureloopofthegallbladderfunduswasheldupbythestickandpushedupwardanteriortotheliver．Withfullexposureofthetriangle，thecysticarteryandductwereeasilyfreedandclipped．Dis—sectionfromthefunduswasroutinelydonewiththehelpofthesutureretraction．Re

6、sultsOnehundredandtenpatientswitheMculouscholecystitishadreceivedthismethodand97cases(88．2％)weresuccessfu1．Theoperationtimewas35～66min(average4min)．Thetimeconsumedbysutureretractionofthegallbladderwas3—7min(average4．2min)．Theremaining13cases(11．8％)wereconvertedtothree—portLCbecauseofharddissection．

7、Nobileleak，bleedingandotherpostoperativecomplicationsoccurred．ConclusionSutureretractionofthegallbladderfundusishelpfulandtime～savingintwo—portLC．[Keywords]Two-port；Laparoscopiccholecystectomy；Sutureretract