【摘要】 目的:评估经脐单孔腹腔镜胆囊切除术不同阶段的手术情况和治疗效果,探讨其学习曲线。方法:回顾性分析我院2010年10月—2012年03月由同一组手术医师完成的80例经脐单孔腹腔镜胆囊切除术的临床资料,按手术时间先后次序分为A、B、C、D 4组,每组20例,比较各组在手术时间、术中出血量、中转率(增加Trocar或开腹)、并发症、术后住院时间、30 d再入院率等方面的差异,分析不同阶段手术效果。结果:4组患者在年龄、性别、体重指数(BMI)、疾病类型方面无明显差异(P>0.05)。A组平均手术时间(59.2±12.9 min)、术中出血量(19.6±8.0 mL)明显高于B组(46.5±11.2 min,13.5±7.3 mL)、C组(44.3±9.3 min,11.2±5.6 mL)、D组(42.5±8.6 min,10.7±4.4 mL),差异有统计学意义(P<0.05)。各组在中转率、并发症、术后住院时间、30 d再入院率方面无明显差异(P>0.05)。手术频数由A组的1.5台/月上升到D组的6台/月。结论:经脐单孔腹腔镜胆囊切除术治疗胆囊良性疾病安全、可行,随着手术经验的积累,手术时间明显缩短,术中出血量减少,学习曲线约为20例。更多还原

【Abstract】 Objective: To evaluate the operative outcomes and effect in various stages of transumbilical single-incision laparoscopic cholecystectomy(SILC)and to define the learning curve of SILC.Methods: The clinical data of 80 patients with benign gallbladder disease performed by same operation team from October 2010 to March 2012 were collected and analysed retrospectively.All cases were divided into 4 groups(group A,group B,group C,group D)according to the time sequence of the operations and 20 cases in each group.The surgical outcomes of four groups,including the operative time,blood loss,frequency of conversion to multi-port cholecystectomy or laparotomy,operative complication,length of hospital stay,readmission within 30 days,were compared statistically,and the laws of learning curve in single-incision laparoscopic cholecystectomy were summarized.Results: There were no significant differences among the patients in the four groups with respect to age,gender,body mass index(BMI),disease types(P>0.05).The operating time(59.2±12.9 min),blood loss(19.6±8.0 mL)of groups A was significantly more than those of groups B(46.5±11.2 min,13.5±7.3 mL),C(44.3±9.3 min,11.2±5.6 mL),D(42.5± 8.6 min,10.7±4.4 mL)(P<0.05).Frequency of conversion to multi-port laparoscopic or laparotomy,operative complication,length of stay,readmission within 30 days among the four groups were also not statistically differen(tP>0.05).The operative frequency of group A D increased from 1.5/month to 6.0/month.Conclusion: Single-incision laparoscopic cholecystectomy was proved to be safe and feasible in selected patients.The operative time and blood loss were improved significantly with increase of operative experience,surgeons can learn such skill after performing 20 cases of SILC.更多还原