单孔腹腔镜胆囊逆行切除术的学习曲线分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 于宏 , 于宏（女） , 王越市 , 肖刚 , 吴硕东

中国医科大学附属盛京医院胆道外科（沈阳 110004）;

Corresponding author：

于宏, Email: yuhong1973@163.com

Keywords：

单孔腹腔镜手术; 胆囊切除; 逆行切除; 传统器械

DOI：

10.7507/1007-9424.201610087

Video：

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目的总结采用常规腹腔镜器械进行逆行切除法在单孔腹腔镜胆囊切除术中应用的学习曲线。方法回顾性分析中国医科大学附属盛京医院单一主刀医生于 2012 年 7 月至 2015 年 12 月期间施行的连续单孔腹腔镜手术的 120 例患者的临床资料，单孔腹腔镜胆囊切除术中采用常规腹腔镜器械进行胆囊逆行切除。结果所有患者的手术都顺利进行。手术施行期间，手术时间随手术例数增加而明显减少，10 例以后手术时间基本稳定。前期组和后期组患者的手术花费、帕瑞昔布钠剂量和美容评分比较差异均无统计学意义（P>0.05），但与前期组比较，后期组的手术时间较短，术中出血量较少，术后住院时间较短，中转多孔率和并发症发生率较低，视觉模拟评分（visual analogue scale，VAS）较低，差异均有统计学意义（P<0.05）。结论单孔腹腔镜胆囊切除术中采用常规腹腔镜器械进行胆囊逆行切除的学习曲线短，易于术者掌握。

Citation： 于宏, 于宏（女）, 王越市, 肖刚, 吴硕东. 单孔腹腔镜胆囊逆行切除术的学习曲线分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(6): 750-753. doi: 10.7507/1007-9424.201610087 Copy

1.	吴万庆, 傅聿铭, 郭晓磊, 等. 单孔腹腔镜与传统腹腔镜胆囊切除术治疗效果比较. 中华实验外科杂志, 2015, 32(1): 160-162.
2.	Wu S, Lv C Jr, Tian Y, et al. Transumbilical single-incision laparoscopic cholecystectomy: long-term review from a single center. Surg Endosc, 2016, 30(8): 3375-3385.
3.	顾强, 汪意青. 常规器械经脐单孔腹腔镜与传统腹腔镜胆囊切除术的疗效比较. 中国现代普通外科进展, 2015, 18(11): 894-896.
4.	Tyagi S, Sinha R, Tyagi A. Single incision laparoscopic cholecystectomy: Less scar, less pain. J Minim Access Surg, 2017, 13(2): 118-123.
5.	Saidy MN, Patel SS, Choi MW, et al. Single incision laparoscopic cholecystectomy performed via the " marionette” technique shows equivalence in outcome and cost to standard four port laparoscopic cholecystectomy in a selected patient population. Am Surg, 2015, 81(10): 1015-1020.
6.	Tay CW, Shen L, Hartman M, et al. SILC for SILC: single institution learning curve for single-incision laparoscopic cholecystectomy. minim invasive surg, 2013, 2013: 381628.
7.	阮月璐. " 悬吊法”经脐单孔腹腔镜下胆囊切除与传统三孔法治疗胆囊良性疾病临床疗效比较与分析. 医药前沿, 2016, 6(15): 217-218.
8.	林叶, 金浩生, 简志祥. 经脐单孔腹腔镜与传统腹腔镜治疗胆囊良性疾病的对比研究. 南方医科大学学报, 2013, 33(8): 1199-1202.
9.	孟凡强, 宁武, 牛晋卫, 等. 经脐单孔腹腔镜阑尾切除术治疗慢性阑尾炎 58 例. 中华普通外科杂志, 2013, 28(6): 421-423.
10.	张陈, 李曦, 雷跃华, 等. 经脐单孔腹腔镜结直肠手术的临床应用. 中华消化外科杂志, 2014, 13(4): 299-301.
11.	骆成玉, 季晓昕, 张键, 等. 经脐单孔腹腔镜胆囊切除术的手术经验. 中华外科杂志, 2011, 49(5): 424-427.
12.	Li T, Kim G, Chang S. Tips and tricks to avoid bile duct injury in SILC: an experience of 500 cases. Surg Endosc, 2016, 30(11): 4750-4755.
13.	Newman RM, Umer A, Bozzuto BJ, et al. Surgical value of elective minimally invasive gallbladder removal: a cost analysis of traditional 4-port vs single-incision and robotically assisted cholecystectomy. J Am Coll Surg, 2016, 222(3): 303-308.
14.	肖思建, 胡三元, 张光永. 经脐单孔腹腔镜与传统腹腔镜胆囊切除术的对比研究. 腹腔镜外科杂志, 2010, 15(7): 501-504.
15.	李欣, 侯纯升, 白洋, 等. 单孔腹腔镜胆囊切除术的学习曲线: 累积求和分析法. 中国微创外科杂志, 2016, 16(3): 241-244.
16.	Srikanth G, Sherry N, Babu P. A technique for gall bladder fundal traction in single-incision laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech, 2011, 21(5): e239-e241.

1. 吴万庆, 傅聿铭, 郭晓磊, 等. 单孔腹腔镜与传统腹腔镜胆囊切除术治疗效果比较. 中华实验外科杂志, 2015, 32(1): 160-162.
2. Wu S, Lv C Jr, Tian Y, et al. Transumbilical single-incision laparoscopic cholecystectomy: long-term review from a single center. Surg Endosc, 2016, 30(8): 3375-3385.
3. 顾强, 汪意青. 常规器械经脐单孔腹腔镜与传统腹腔镜胆囊切除术的疗效比较. 中国现代普通外科进展, 2015, 18(11): 894-896.
4. Tyagi S, Sinha R, Tyagi A. Single incision laparoscopic cholecystectomy: Less scar, less pain. J Minim Access Surg, 2017, 13(2): 118-123.
5. Saidy MN, Patel SS, Choi MW, et al. Single incision laparoscopic cholecystectomy performed via the " marionette” technique shows equivalence in outcome and cost to standard four port laparoscopic cholecystectomy in a selected patient population. Am Surg, 2015, 81(10): 1015-1020.
6. Tay CW, Shen L, Hartman M, et al. SILC for SILC: single institution learning curve for single-incision laparoscopic cholecystectomy. minim invasive surg, 2013, 2013: 381628.
7. 阮月璐. " 悬吊法”经脐单孔腹腔镜下胆囊切除与传统三孔法治疗胆囊良性疾病临床疗效比较与分析. 医药前沿, 2016, 6(15): 217-218.
8. 林叶, 金浩生, 简志祥. 经脐单孔腹腔镜与传统腹腔镜治疗胆囊良性疾病的对比研究. 南方医科大学学报, 2013, 33(8): 1199-1202.
9. 孟凡强, 宁武, 牛晋卫, 等. 经脐单孔腹腔镜阑尾切除术治疗慢性阑尾炎 58 例. 中华普通外科杂志, 2013, 28(6): 421-423.
10. 张陈, 李曦, 雷跃华, 等. 经脐单孔腹腔镜结直肠手术的临床应用. 中华消化外科杂志, 2014, 13(4): 299-301.
11. 骆成玉, 季晓昕, 张键, 等. 经脐单孔腹腔镜胆囊切除术的手术经验. 中华外科杂志, 2011, 49(5): 424-427.
12. Li T, Kim G, Chang S. Tips and tricks to avoid bile duct injury in SILC: an experience of 500 cases. Surg Endosc, 2016, 30(11): 4750-4755.
13. Newman RM, Umer A, Bozzuto BJ, et al. Surgical value of elective minimally invasive gallbladder removal: a cost analysis of traditional 4-port vs single-incision and robotically assisted cholecystectomy. J Am Coll Surg, 2016, 222(3): 303-308.
14. 肖思建, 胡三元, 张光永. 经脐单孔腹腔镜与传统腹腔镜胆囊切除术的对比研究. 腹腔镜外科杂志, 2010, 15(7): 501-504.
15. 李欣, 侯纯升, 白洋, 等. 单孔腹腔镜胆囊切除术的学习曲线: 累积求和分析法. 中国微创外科杂志, 2016, 16(3): 241-244.
16. Srikanth G, Sherry N, Babu P. A technique for gall bladder fundal traction in single-incision laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech, 2011, 21(5): e239-e241.

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单孔腹腔镜胆囊逆行切除术的学习曲线分析

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