目的 总结三孔法行腹腔镜胆囊切除术(LC)的方法和体会。方法 对119例三孔法LC病例进行回顾性分析。经脐部10 mm孔、剑突下10 mm孔及右上腹5 mm孔实施手术。结果 106例成功施行三孔法LC,12例中转四孔法LC,1例中转行开腹胆囊切除手术。全组患者均痊愈出院,无并发症发生。结论 在四孔法LC操作熟练的基础上选择适当病例开展三孔法LC是安全和可行的，更符合微创和美观的要求，但操作难度较大，对术者要求更高。
Objective To discuss the safety，feasibility，and advantages of two-port laparoscopic cholecystectomy （LC）．Methods The clinical data of 114 patients underwent LC from June 2008 to October 2010 were retrospectively analyzed，of which 46 underwent two-port LC （two-port LC group，n=46） and 68 underwent three-port LC （three-port LC group，n=68）. The operation time，intraoperative blood loss，postoperative feeding time，postoperative pain，postoperative hospital stay，and hospitalization expenses were compared between two groups. Results All the operations were successful，no postoperative complications occurred in both groups．The operation time in the two-port LC group was longer than that in the three-port LC group （P＜0.05）. The intraoperative blood loss，postoperative feeding time，postoperative pain，and postoperative hospital stay had no significant differences in two groups （P＞0.05）. The hospitalization expenses in the two-port group was less than that in the three-port group（P＜0.05）. Conclusions Two-port LC is a safe and feasible operation in the simple gallstone patients. It is cautious in those patients with acute cholecystitis because of the restricted vision and operation．
目的 探讨腹腔镜阑尾切除术的临床经验和应用价值。方法 回顾性分析腹腔镜二孔法阑尾切除术 39例(二孔法组)和三孔法阑尾切除术70例(三孔法组)的临床资料。结果 顺利完成手术107例； 中转开腹2例,其中阑尾严重粘连1例,腹膜后阑尾1例。术后发生粘连性肠梗阻1例,经保守治疗痊愈出院。住院时间2~9 d,平均3 d。随访全部患者2~24个月,平均12个月,未发生其他并发症。结论 腹腔镜阑尾切除术具有创伤少、并发症发生率低及恢复快的优点,将成为阑尾切除术的首选术式。腹腔镜二孔法阑尾切除术操作简单,易于推广; 三孔法则具有处理复杂阑尾切除术的优势。
ObjectiveTo explore the feasibility and characteristics of three-port laparoscopic cholecystectomy (LC) in the treatment of cholecystitis with gallbladder calculi incarceration. MethodsThe clinical data of 160 patients with gallbladder calculi incarceration treated by three-port LC between July 2010 and December 2014 were analyzed retrospectively. Among the patients, there were 104 cases of calculi incarcerated in the gallbladder neck area, 20 cases in the cystic gall duct, and 36 cases in the gallbladder ampullar region. Elective operations were carried out for 120 patients and 40 underwent emergency operation. ResultsThree-port LC was successfully completed in 154 patients (96.25%), and the other 6 patients were converted to open surgery among whom 2 underwent elective operation (1.67%) and 4 underwent emergency operation (10.00%). Two converted patients in the elective operation group had Mirizzi syndrome and gallbladder carcinoma respectively; all the 4 converted patients in the emergency operation group had a disease course of about one week with compacted triangle structure and gallbladder edema thickening of 1.0 cm, causing difficult separation under laparoscope. Seventy patients had varying degrees of enlargement and edema of gallbladder, 60 had varying degrees of gallbladder atrophy, and 30 had almost normal gallbladder. There were 80 cases of dark green thick bile, 10 of purulent bile, 40 of white bile, and 30 of empty gallbladder and no bile. No complications were found during the follow-up of 6 to 36 months, except that one patient was found to have secondary common bile duct stones three months after discharge, and the patient was cured by endoscopic retrograde cholangiopancreatography. Conclusions Elective or emergency three-port LC is safe and feasible for gallbladder calculi incarceration as long as the operator had skilled technique and made the right decision on opportunity of conversion.
ObjectiveTo investigate the clinical effect of three-port Da Vinci robot-assisted radical resection of lung cancer. MethodsThe clinical data of patients who underwent Da Vinci robot-assisted radical resection of lung cancer in the Second Department of Thoracic Surgery, the First Affiliated Hospital of Xiamen University from April 2021 to March 2022 were retrospectively analyzed. According to the number of surgical ports, they were divided into two groups: a three-port group (three-port Da Vinci robot-assisted radical resection of lung cancer), and a four-port group (traditional Da Vinci robot-assisted radical resection of lung cancer). The operation time, intraoperative bleeding, lymphadenectomy, total thoracic drainage, extubation time, postoperative complications and postoperative pain of the two groups were compared and analyzed. ResultsA total of 58 patients were included, including 19 males and 39 females, aged 31-79 years. There were 21 patients in the three-port group, and 37 patients in the four-port group. The visual analogue scores on the first and third day after the operation were 4.33±1.20 points and 2.24±0.77 points in the three-port group, and 5.11±1.22 points and 2.78±1.06 points in the four-port group, and there were statistical differences between the two groups (P<0.05). There was no significant difference between the two groups in terms of operation time, intraoperative bleeding, lymph node dissection, postoperative thoracic drainage, time of thoracic tube insertion or postoperative complications (P>0.05). ConclusionThree-port Da Vinci robot-assisted radical resection of lung cancer can reduce the postoperative pain without increasing the operation difficulty and complications, and can be widely used in the clinical practice.
Laparoscopic sleeve gastrectomy (LSG) is an effective and lasting method for treating obesity, type 2 diabetes and other obesity related metabolic diseases. The symmetrical three-port LSG has been proven to be a simple, safe, and effective surgical procedure. However, China still lacks standardized surgical operation guidelines for this method. This guideline provides a detailed description of the various steps and key details of the symmetrical three-port LSG, aiming to standardize and normalize the symmetrical three-port LSG in the bariatric and metabolic field in China, and to provide standardized surgical procedures for clinical surgeons in this field.
A lot of evidence-based medical evidence has shown that laparoscopic Roux-en-Y gastric bypass (LRYGB) is a durable and effective method for obesity and diabetes, and can significantly improve a series of obesity-related metabolic complications. This guideline provides a detailed description of the main operating steps and technical points of the symmetric three-port LRYGB, including posture layout, trocar position selection, liver suspension, gauze exposure, production of small gastric sacs, gastrojejunal anastomosis and production of biliary pancreatic branches, entero-enteric side to side anastomosis, closure of gastrointestinal anastomosis and mesenteric hiatus, greater omentum coverage, and closure of incisions. The purpose is to standardize the operating process of the symmetrical three hole method of LRYGB, providing standardized surgical operation references for clinical doctors in the field of obesity metabolic surgery.