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中华腔镜外科杂志(电子版) ›› 2024, Vol. 17 ›› Issue (04) : 193 -198. doi: 10.3877/cma.j.issn.1674-6899.2024.04.001

指南与共识

单孔腹腔镜胆囊切除术中国专家共识(2024版)
中国研究型医院学会微创外科学专业委员会   
  • 收稿日期:2024-07-19 出版日期:2024-08-30

Chinese expert consensus on single-incision laparoscopic cholecystectomy

Minimally Invasive Surgery Committee of the Chinese Research Hospital Association   

  • Received:2024-07-19 Published:2024-08-30
引用本文:

中国研究型医院学会微创外科学专业委员会. 单孔腹腔镜胆囊切除术中国专家共识(2024版)[J]. 中华腔镜外科杂志(电子版), 2024, 17(04): 193-198.

Minimally Invasive Surgery Committee of the Chinese Research Hospital Association. Chinese expert consensus on single-incision laparoscopic cholecystectomy[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(04): 193-198.

胆囊切除术是治疗胆囊良性疾病最有效的方法。相比传统开腹手术方式,腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)具有创伤小、痛苦轻、住院时间短等优势。随着近十几年腹腔镜器械、设备的完善及外科医师操作水平的提高,单孔腹腔镜胆囊切除术(single-incision laparoscopic cholecystectomy,SILC)得到了较大发展。与传统LC相比,SILC更加符合微创的理念,在美容效果、术后疼痛等方面更具优势。为进一步推动我国SILC的规范化开展,中国研究型医院学会微创外科学专业委员会组织国内相关领域的专家,借鉴国外相关文献及指南,结合我国的研究成果与临床实践,对SILC规范化开展方面的关键内容进行反复讨论,对有争议的问题进行投票,最终形成《单孔腹腔镜胆囊切除术中国专家共识(2024版)》。本共识对SILC的技术优势、适应证、单孔设备与操作器械选择、手术要点、并发症、术者培训等方面给出推荐意见,旨在完善SILC的患者选择和操作规范,促进SILC的临床应用与推广。

Cholecystectomy is the most effective treatment for benign gallbladder diseases. Compared to traditional open surgery, laparoscopic cholecystectomy (LC) offers advantages such as less trauma, reduced pain, and shorter hospital stays. In recent years, with improvements in laparoscopic instruments, equipment, and the skill level of surgeons, single-incision laparoscopic cholecystectomy (SILC) has seen significant development. SILC aligns more closely with the concept of minimally invasive surgery and offers advantages in terms of cosmetic outcomes and postoperative pain compared to LC. To further promote the standardized implementation of SILC in China, the Minimally Invasive Surgery Committee of the Chinese Research Hospital Association convened experts in relevant fields. Drawing from international literature and guidelines, and combining domestic research findings and clinical practices, these experts engaged in extensive discussions on key aspects of SILC standardization and conducted voting on contentious issues. The result is the "Chinese Expert Consensus on Single-Incision Laparoscopic Cholecystectomy (2024 Edition)" . This consensus provides recommendations on the technical advantages of SILC, indications, selection of single-incision devices and instruments, surgical key points, complications, and surgeon training. The goal is to improve the patient selection and operation standard of SILC, and promote its clinical application and dissemination.

表1 证据质量评估及推荐强度分级
图1 术者站位
1
Kim SS, Donahue TR. Laparoscopic cholecystectomy[J]. JAMA, 2018, 319(17):1834.
2
Agresta F, Campanile FC, Vettoretto N, et al. Laparoscopic cholecystectomy: consensus conference-based guidelines[J]. Langenbecks Arch Surg, 2015, 400(4):429-453.
3
Abd Ellatif ME, Askar WA, Abbas AE, et al. Quality-of-life measures after single-access versus conventional laparoscopic cholecystectomy: a prospective randomized study[J]. Surg Endosc, 2013, 27(6):1896-1906.
4
Bucher P, Pugin F, Buchs NC, et al. Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy[J]. Br J Surg, 2011, 98(12):1695-1702.
5
Jørgensen LN, Rosenberg J, Al-Tayar H, et al. Randomized clinical trial of single-versus multi-incision laparoscopic cholecystectomy[J]. Br J Surg, 2014, 101(4):347-355.
6
孙栋,刘少壮,张光永. 单孔腹腔镜技术在普通外科的应用[J]. 腹腔镜外科杂志2011, 16(2):149-151.
7
Wang D, Wang Y, Ji ZL. Laparoendoscopic single-site cholecystectomy versus conventional laparoscopic cholecystectomy: a systematic review of randomized controlled trials[J]. ANZ J Surg, 2012, 82(5):303-310.
8
康利民,郑永,施红宁,等. 急性胆囊炎单孔腹腔镜胆囊切除术与传统腹腔镜手术的对比研究[J]. 腹腔镜外科杂志2017, 22(11):835-838.
9
Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables[J]. J Clin Epidemiol, 2011, 64(4):383-394.
10
Morales-Conde S, Peeters A, Meyer YM, et al. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery[J]. Surg Endosc, 2019, 33(4):996-1019.
11
Arezzo A, Passera R, Bullano A, et al. Multi-port versus single-port cholecystectomy: results of a multi-centre, randomised controlled trial (MUSIC trial)[J]. Surg Endosc, 2017, 31(7):2872-2880.
12
Pereira C, Gururaj S. A systematic review and meta-analysis of single-incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy[J]. Cureus, 2022, 14(12):e32524.
13
Qiu Z, Sun J, Pu Y, et al. Learning curve of transumbilical single incision laparoscopic cholecystectomy (SILS): a preliminary study of 80 selected patients with benign gallbladder diseases[J]. World J Surg, 2011, 35(9):2092-2101.
14
Pan MX, Jiang ZS, Cheng Y, et al. Single-incision vs three-port laparoscopic cholecystectomy: prospective randomized study[J]. World J Gastroenterol, 2013, 19(3):394-398.
15
Wu XS, Shi LB, Gu J, et al. Single-incision laparoscopic cholecystectomy versus multi-incision laparoscopic cholecystectomy: a meta-analysis of randomized clinical trials[J]. J Laparoendosc Adv Surg Tech A, 2013, 23(3):183-191.
16
李晓龙,吴硕东,韩金岩,等. 单孔法与三孔腹腔镜胆囊切除术的临床对比研究[J].中国现代普通外科进展2012, 15(12):990-991,996.
17
张文新,黄安华,朱江帆,等. 用TriPort单孔腹腔镜胆囊切除术的临床研究[J/CD]. 中华腔镜外科杂志(电子版), 2011, 4(3):191-195.
18
赵国栋,许大彬,刘荣,等. 经脐单孔腹腔镜胆囊切除临床分析[J/CD]. 中华腔镜外科杂志(电子版), 2010, 3(1):113-118.
19
胡三元,张光永. 悬吊式经脐单孔腹腔镜胆囊切除术[J/CD].中华腔镜外科杂志(电子版), 2009, 2(1):13-15.
20
伏洁,刘永永,樊勇,等. 改良式经脐单孔腹腔镜与传统腹腔镜胆囊切除术的比较[J].中国微创外科杂志2019, 19(7):606-609.
21
刘南,张光永,胡三元. 悬吊式经脐单孔腹腔镜胆囊切除术与传统腹腔镜胆囊切除术的对比研究[J].腹腔镜外科杂志2011, 16(2):95-99.
22
韩威,张忠涛,李建设,等. 经脐单孔腹腔镜胆囊切除术(附12例报告及文献复习)[J]. 中国实用外科杂志2008, 28(11):967-969.
23
Hajong R, Hajong D, Natung T, et al. A comparative study of single incision versus conventional four ports laparoscopic cholecystectomy[J]. J Clin Diagn Res, 2016, 10(10):PC06-PC09.
24
Guo W, Liu Y, Han W, et al. Randomized trial of immediate postoperative pain following single-incision versus traditional laparoscopic cholecystectomy[J]. Chin Med J (Engl), 2015, 128(24):3310-3316.
25
郭伟,张忠涛,韩威,等. 经脐单孔腹腔镜胆囊切除术120例回顾性分析[J]. 中国实用外科杂志2010, 30(4):304-306,317.
26
Piché ME, Tchernof A, Després JP. Obesity phenotypes, diabetes, and cardiovascular diseases[J]. Circ Res, 2020, 126(11):1477-1500.
27
Perdomo CM, Cohen RV, Sumithran P, et al. Contemporary medical, device, and surgical therapies for obesity in adults[J]. Lancet, 2023, 401(10382):1116-1130.
28
Matos-Azevedo AM, Díaz-Guëmes Martín-Portugués I, Pérez-Duarte FJ, et al. Comparison of single access devices during cut and suturing tasks on simulator[J]. J Surg Res, 2014, 192(2):356-367.
29
Wu S, Lv C Jr, Tian Y, et al. Transumbilical single-incision laparoscopic cholecystectomy: long-term review from a single center[J]. Surg Endosc, 2016, 30(8):3375-3385.
30
Tsai AY, Selzer DJ. Single-port laparoscopic surgery[J]. Adv Surg, 2010, 44:1-27.
31
Zhao L, Wang Z, Xu J, et al. A randomized controlled trial comparing single-incision laparoscopic cholecystectomy using a novel instrument to that using a common instrument[J]. Int J Surg, 2016, 32:174-178.
32
Yin H, Wang Z, Xu J, et al. A specific instrument to facilitate single-incision laparoscopic cholecystectomy: an initial experience[J]. Surg Innov, 2011, 18(3):289-293.
33
韩金岩,吴硕东,田雨. 完全经脐单孔腹腔镜胆囊切除术10例报告[J]. 中国实用外科杂志2010, 30(7):587-589.
34
韩金岩,吴硕东,田雨. 完全经脐单孔腹腔镜胆囊切除术30例临床应用分析[J/CD]. 中华腔镜外科杂志(电子版), 2009, 2(1):16-19.
35
张光永,胡三元,李峰. 经脐单孔腹腔镜胆囊切除术[J]. 腹腔镜外科杂志2009, 14(1):18-20.
36
陈英,林琳,付庆辉,等. 单孔腹腔镜与传统腹腔镜胆囊切除的比较研究[J]. 中国普外基础与临床杂志2009, 21(2):217-219.
37
余锋,田志强,柏杨,等. 腹腔镜胆囊切除术早期并发症的临床风险因素分析[J]. 中国普通外科杂志2015, 24(8):1130-1134.
38
欧希,刘吉奎,尹耀新,等. 腹腔镜胆囊切除术中损伤副肝管导致迟发性胆漏的腹腔镜治疗价值[J].腹腔镜外科杂志2012, 17(11):837-842.
39
Chamberlain RS, Sakpal SV. A comprehensive review of single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy[J]. J Gastrointest Surg, 2009, 13(9):1733-1740.
40
姚春,朱丽丹,王凌云,等. 经脐单孔腹腔镜胆囊切除术后切口感染的列线图模型预测价值研究及防治策略分析[J]. 现代生物医学进展2022, 22(7):1319-1323.
41
Haueter R, Schütz T, Raptis DA, et al. Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis[J]. Br J Surg, 2017, 104(9):1141-1159.
42
Ma J, Cassera MA, Spaun GO, et al. Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy[J]. Ann Surg, 2011, 254(1):22-27.
43
Merchant AM, Cook MW, White BC, et al. Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS)[J]. J Gastrointest Surg, 2009, 13(1):159-162.
44
Pryor AD, Tushar JR, DiBernardo LR. Single-port cholecystectomy with the TransEnterix SPIDER: simple and safe[J]. Surg Endosc, 2010, 24(4):917-923.
45
中华医学会外科学分会胆道外科学组,中国医师协会外科医师分会胆道外科医师委员会. 胆囊切除术后常见并发症的诊断与治疗专家共识(2018版)[S]. 全科医学临床与教育2018, 16(3):244-246.
46
曹嵘,王贵阳,李可为,等. 单中心317例日间单孔腹腔镜胆囊切除术临床疗效分析[J]. 肝胆胰外科杂志2021, 33(12):750-754.
47
中国研究型医院学会微创外科学专业委员会. 日间腹腔镜胆囊切除术专家共识[S]. 腹腔镜外科杂志2023, 28(8):561-567,573.
48
Trujillo Loli Y, Rodríguez-Luna MR, Noriega-Usi VM, et al. Single-port laparoscopic cholecystectomy assisted with neodymium magnets: initial prospective experience with 60 cases[J]. J Laparoendosc Adv Surg Tech A, 2020, 30(5):525-530.
49
Tay CW, Shen L, Hartman M, et al. SILC for SILC: single institution learning curve for single-incision laparoscopic cholecystectomy[J]. Minim Invasive Surg, 2013:381628.
50
Feinberg EJ, Agaba E, Feinberg ML, et al. Single-incision laparoscopic cholecystectomy learning curve experience seen in a single institution[J]. Surg Laparosc Endosc Percutan Tech, 2012, 22(2):114-117.
51
Pan MX, Liang ZW, Cheng Y, et al. Learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy[J]. World J Gastroenterol, 2013, 19(29):4786-4790.
52
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[J].中国微创外科杂志2016, 16(3):241-244.
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