基于常规器械行经脐单孔腹腔镜辅助腹内法与腹外法阑尾切除术的临床比较

Clinical comparison of intracorporeal versus extracorporeal approach of transumbilical single-port laparoscopic appendectomy with conventional laparoscopic instruments

目的比较使用常规腔镜器械行经脐单孔腹腔镜辅助腹内法与腹外法阑尾切除术的临床疗效,为基于常规器械的单孔腹腔镜辅助下儿童阑尾切除术提供多元化选择。方法2020年1月至2022年1月广州医科大学附属广州市妇女儿童医疗中心共收治291例急性阑尾炎患儿,280例行手术治疗,根据纳入标准对其中113例进行回顾性分析,其中行腹内法阑尾切除术(腹内组)48例、腹外法阑尾切除术(腹外组)65例。对两组患儿基线资料、手术情况及治疗效果进行比较。结果两组均顺利完成手术,腹内组与腹外组手术年龄[(8.7±3.2)岁比(7.8±1.8)岁]、身体质量指数[(18.1±1.6)kg/m^(2)比(17.7±0.9)kg/m^(2)]差异无统计学意义(P>0.05),手术时间[(86.5±27.7)min比(50.2±22.6)min]差异有统计学意义(P<0.05),术中出血量[(6.7±3.2)mL比(5.9±2.2)mL]、术后肠功能恢复时间[(21.3±5.3)h比(20.1±3.6)h]以及术后住院时间[(7.1±2.1)d比(6.7±1.3)d]差异均无统计学意义(P>0.05)。腹内组术后出现并发症5例,其中腹腔脓肿2例,切口感染、肠梗阻、肠管副损伤各1例;腹外组术后出现并发症7例,其中腹腔脓肿3例,切口感染、肠梗阻各2例;两组并发症发生率[10.5%(5/48)比10.8%(7/65)]差异无统计学意义(P>0.05)。结论基于常规器械的经脐单孔腹腔镜辅助腹内法与腹外法阑尾切除术治疗儿童急性阑尾炎均安全可行、疗效确切,二者在并发症发生率、术后肠功能恢复时间及术后住院时间等无显著差异,但腹外法较腹内法手术难度更低,能明显缩短手术时间。

Objective To compare the efficacies of intracorporeal versus extracorporeal approach of transumbilical single-port laparoscopic appendectomy(TUSPLA)and provide diversified options for acute appendicitis(AA)in children with conventional laparoscopic instruments.Methods From January 2020 to January 2022,a total of 291 AA children were hospitalized and 280 of them underwent appendectomy.According to the inclusion criteria,clinical data were retrospectively reviewed for 113 children.Intracorporeal appendectomy(intra-group,n=48)and extracorporeal appendectomy(extra-group,n=65)were performed.Clinical baseline data,intraoperative findings and efficacies were compared between two groups.Results All children underwent operations successfully.Age[(8.7±3.2)vs(7.8±1.8)years]and body mass index(BMI)[(18.1±1.6)vs(17.7±0.9)kg/m^(2)]showed no significant inter-group difference(P>0.05);operative duration[(86.5±27.7)vs(50.2±22.6)min]was significantly different(P<0.05);blood loss[(6.7±3.2)vs(5.9±2.2)mL],postoperative exhaust time[(21.3±5.3)vs(20.1±3.6)h],postoperative hospital stay[(7.1±2.1)vs(6.7±1.3)day]and complication rate[10.5%(5/48)vs 10.8%(7/65)]showed no significant inter-group differences(P>0.05);In intra-group,5 cases developed complications,including abdominal abscess(n=2),incision infection(n=1),postoperative intestinal obstruction(n=1)and intestinal side injury(n=1);Seven cases became complicated in extra-group,including abdominal abscess(n=3),incision infection(n=2)and postoperative intestinal obstruction(n=2).Conclusion Both types of TUSPLA with conventional laparoscopic instruments are safe and feasible with definite efficacies.No significant differences exist in complication rate,postoperative recovery time of intestinal function or postoperative hospital stay.However,extracorporeal approach is less difficult than intracorporeal approach and it may significantly shorten operative duration.