单孔腹腔镜手术中的打结技术初探

Knotting technique in single incision laparoscopic surgery

摘要:

目的 探讨单孔腹腔镜手术中打结技术的应用。方法 2011年7月-2013年10月该科完成的单孔腹腔镜手术中共有48例应用了打结技术。其中，包括单孔腹腔镜阑尾切除术32例、单孔腹腔镜胆囊切除术16例。其中，20例使用了单纯结扎法，28例使用了结扎+夹闭法。结果 48例患者均成功完成单孔腹腔镜手术，无1例中转开腹或传统多孔法腹腔镜手术。术后2例阑尾切除术患者发生伤口感染，经伤口敞开换药清洗后痊愈，1例胆囊切除术患者发生少量胆漏，经充分引流后于术后3 d自愈，无1例发生术后肠瘘、腹腔内出血、肠梗阻、腹腔脓肿。结论 掌握单孔腹腔镜手术下打结技术相当重要，是应付术中各种情况以及开展高难度复杂手术的重要前提。对于管道结构的闭合首选结扎+夹闭法。具体打结方式中体外推结法和体内外结合递线法操作简便、费时最短、可单钳操作，最适用于单孔腹腔镜。

Abstract:

【Objective】 To investigate the application of extracorporeal with intracorporeal knotting technique in laparoscopic surgery. 【Methods】 Knotting technique was applied in 48 cases of single incision laparoscopic surgery (SILS) from July 2011 to October 2013 in our department, including 32 cases of single incision laparoscopic appendectomy (SILA), 16 cases of single incision laparoscopic cholecystectomy (SILC). Complete ligation was applied in 20 cases and clipping with ligation in 28 cases. 【Results】 48 cases were successfully performed with SILS without conversion. Two cases of SILA developed wound infection which were cured by dressing change. One case of SILC developed bile leakage which was cured by drainage, None developed gastrointestinal leakage, intraperitoneal hemorrhage, intestinal obstruction or intraperitoneal abscess. 【Conclusion】 It's significant to master knotting technique in SILS, which helps to handle complex situation during surgery and develop advanced surgeries of SILS. Clipping with ligation should be the first choice for closing pipeline structure. In term of knot tying method, extracorporeal pushing-knot technique and extracorporeal with intracorporeal delivery-knot technique are easy, rapid, and only need single forceps, which are best suited for SILS.