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Abstract：
Aims A prospective observational study was performed to assess the feasibility and safety of three-port laparoscopic cholecystectomy. Parameters comprising age, sex, number of cases in which intra-operative difficulty were encountered, and outcomes such as number of cases that required conversion to four-port laparoscopic cholecystectomy, postoperative pain on the visual analog scale (VAS), and postoperative hospital stay were assessed. We also documented difficult cases that were operated successfully with three ports, and the number of cases that needed conversion to four ports along with the reason for the conversion. Material and methods The patients were operated upon in the supine position in all cases. A pre-emptive analgesia with 1% lignocaine was administered in all cases prior to making the incision. The first port was 10-mm supraumbilical and inserted by the open technique. After insertion of the umbilical port, pneumoperitoneum was created by maintaining a maximum pressure of 12 mmHg and a flow rate of 8 L/minute. A camera head with a 30° telescope was introduced in the peritoneal cavity, and diagnostic laparoscopy was performed. A 10-mm subxiphoid port and a 5-mm subcostal port were placed under vision, with the latter placed more lateral and inferior to the conventional port position for better triangulation and ergonomics. The outcomes measured were operative time, the number of cases requiring a fourth port, postoperative pain (VAS), and postoperative hospital stay (number of days patients stayed in the hospital post-surgery until discharge). Data were collected using MS Excel, and an analysis was performed using SPSS Version 21.0. Results Data of 102 patients were analyzed prospectively. The mean age of the patients was 50.98 years, with an SD of 16.88, and the gender ratio was 73:29 (female: male). The mean operative time was 52.68 ± 20.84 minutes, with an SD of 20.84. Difficulty was encountered in 18.6% of cases in the form of pericholecystic adhesions, aberrant Calot\'s anatomy, empyema or mucocele of the gallbladder, or bleeding from the liver bed or cystic artery stump. Postoperative pain was less in our study due to the reduced number of ports and the use of a pre-emptive analgesia, with a mean VAS score of 1.22 and an SD of 0.56. The mean postoperative hospital stay was 1.08 days, with an SD of 0.31. We needed to convert to a four-port procedure for safety in 2.9% cases. The operative time and postoperative hospital stay in our study were similar to those of other studies, but our average pain score was less due to the use of the pre-emptive analgesia. Only three cases required conversion to four ports, and 99 cases were successfully managed with three ports without compromising safety. No bile duct injury occurred in any of our 102 cases. Conclusion From this study, we conclude that three-port cholecystectomy is feasible, and it can be performed even in difficult cases without compromising safety. The surgical time is similar to that of four-port cholecystectomy, and the postoperative stay is shorter. The decreased number of ports and the pre-emptive analgesia reduced postoperative pain, cosmesis was better, and the incidence of bile duct injury did not increase. The procedure can also be converted to four-port cholecystectomy at any time if safety is compromised. Therefore, three-port cholecystectomy is a viable and safe option in the treatment of gallstone disease.
摘要：
目的进行一项前瞻性观察性研究，以评估三孔腹腔镜胆囊切除术的可行性和安全性。参数包括年龄，性别,术中遇到困难的病例数，以及结果，例如需要转换为四孔腹腔镜胆囊切除术的病例数，术后疼痛视觉模拟量表（VAS），评估术后住院时间。我们还记录了三个港口成功运营的疑难案件，以及需要转换到四个端口的案例数以及转换的原因。材料和方法在所有情况下，患者均以仰卧位进行手术。在所有情况下，在切口前都使用1％利多卡因进行超前镇痛。第一个端口是10毫米的脐带上，并通过开放技术插入。插入脐带缆端口后，通过保持最大压力为12mmHg和流量为8L/分钟来产生气腹。在腹膜腔中引入了带有30°望远镜的摄像头，并进行了诊断性腹腔镜检查。一个10毫米的剑突下端口和一个5毫米的肋下端口放置在视野下，与后者放置更多的横向和劣于传统的端口位置更好的三角测量和人体工程学。测量的结果是手术时间，需要第四个端口的案件数量，术后疼痛（VAS），和术后住院时间(术后患者住院至出院的天数).使用MSExcel收集数据，并使用SPSS版本21.0进行分析。结果对102例患者的资料进行前瞻性分析。患者的平均年龄为50.98岁,SD为16.88，性别比例为73：29（女性：男性）。平均手术时间52.68±20.84分钟,SD为20.84。在18.6％的病例中遇到困难，以胆囊周围粘连的形式出现，卡洛特的解剖结构异常,胆囊脓胸或粘液囊肿，或从肝床或胆囊动脉残端出血。在我们的研究中，由于端口数量减少和使用先发制人的镇痛，术后疼痛较少。平均VAS评分为1.22，SD为0.56。术后平均住院时间为1.08天,SD为0.31。在2.9％的情况下，我们需要转换为四端口程序以确保安全。我们研究的手术时间和术后住院时间与其他研究相似，但由于使用了先发制人镇痛,我们的平均疼痛评分较低.只有三种情况需要转换为四个端口，在不影响安全的情况下，通过三个港口成功管理了99起案件。在我们的102例中，没有发生胆管损伤。结论从这项研究来看，我们得出结论，三孔胆囊切除术是可行的，即使在困难的情况下也可以执行，而不会损害安全性。手术时间与四孔胆囊切除术相似，术后住院时间较短。端口数量的减少和超前镇痛减少了术后疼痛，宇宙更好，胆管损伤的发生率没有增加。如果安全性受损，该程序也可以随时转换为四口胆囊切除术。因此,三孔胆囊切除术是治疗胆结石疾病的一种可行且安全的选择.
