【摘要】 目的探讨临床开展经自然腔道内镜手术(PURE NOTES),采用经阴道腹腔镜切除胆囊的可行性、安全性和优越性。方法胃镜下针刀切开阴道后穹窿3cm,切口处安放"三通转换器"(Single Incision Laparoscopic Surgery Port,SILS PORT),三通道内分别插入3个软性器械套管建立防止漏气的通道,充气后首先于SILSPORT6点位通道进入腹腔镜探查腹盆腔情况,并监视硬质弯曲操作器械通过3点及9点位的通道到达胆囊区。分离出胆囊管及胆囊动脉,置入钛夹,分别夹闭胆囊管及胆囊动脉,常规切除胆囊,电凝胆囊床,将胆囊从阴道取出体外。结果胆囊切除时间39min,出血量2mL,未放引流,术后无阴道分泌物、无出血、胆漏等并发症,几乎无腹部疼痛,恢复快,术后第3天康复出院。结论 PURE NOTES经阴道腹腔镜胆囊切除术技术可行,操作安全,相比传统腹腔镜手术有明显优势,是目前开展PURE NOTES的较好方法 。更多还原

【Abstract】 Objective To investigate the feasibility,safety and superiority of the world’s first pure NOTES transvaginal laparoscopic cholecystectomy in clinical application.Methods One patient with stable cholecystolithiasis and chronic cholecystitis.We targeted the lithotomy position,and used acupotomy to cut the posterior fornix of vagina 3cm under gastroscope.The single incision laparoscopic surgery port (Single Incision Laparoscopic Surgery Port,SILS PORT) was placed in the incision and three soft manipulator cannulas were inserted in three channels separately to establish the channels against leakage.After inflation,we placed the laparoscope in the abdominal cavity through 6 o’clock position channel of SILS PORT to check if there was accretio in abdominal cavity and cavitas pelvis,monitoring the curvate manipulators to reach at the cholecyst through the 3 and 9 o’clock position channels.We separated the cystic duct and cystic artery,and did the occlusion with the titanium clamp separately.Then we did the routine cholecystectomy,the electrocoagulation of gallbladder bed and the removal of gallbladder from the vagina orifice.Results The operation was performed successfully.The cholecystectomy operating time was 39 min with 2ml bleeding and no drainage.No vaginal secreta,bleeding,bile leakage or other complications occurred postoperatively.There was nearly no abdominal pain for the patient.For the quick recovery,the patient discharged from the hospital on postoperative third day.Conclusion PURE NOTES transvaginal laparoscopic cholecystectomy is feasible and safety.Compared to traditional laparoscopic operation,it has obvious superiority.It is a better way to develop PURE NOTES nowadays.更多还原