微型腹腔镜单孔阑尾切除术治疗急、慢性阑尾炎

Single Pore Microlaparoscopic Appendectomy

目的:探讨微型腹腔镜单孔阑尾切除术(One-pore microlaparoscopic appendectomy,OMLA)治疗急、慢性阑尾炎的临床疗效。方法:118例急、慢性阑尾炎患者随机分为两组:OLMA组53例LA组65例。OMLA组采用微型腹腔镜单孔阑尾切除术;LA组采用腹腔镜阑尾切除术。并观察两组的手术时间、术中失血量、术后肠道功能恢复时间、术后体温恢复正常时间、住院时间和疼痛情况。结果:OMLA组手术时间(23.58±8.07)min,短于LA组(36.43±7.32)min(t=9.0579,P=0.0000);术中出血量:MOLA组(10.9±2.5)mL与LA组(11.3±3.2)mL之间差异无统计学意义(t=0.7434,P=0.4587);OMLA组术后肠道功能恢复时间(16.0±5.3)h,明显短于LA组(29.0±10.1)h(t=8.4639,P=0.0000);OMLA组术后体温恢复正常时间(29.0±8.3)h,明显短于LA组(41.0±16.2)h(t=4.8919,P=0.0000);住院时间:OMLA组(2.5±1.5)d与LA组(3.0±2.1)d之间差异无统计学意义(t=1.4562,P=0.1480);术后切口疼痛消失平均时间:OMLA组(39.0±12.9)h,明显短于LA组(56.0±21.2)h(t=5.1144,P=0.0000)。两组患者术后随访7 d^1.5年,平均8个月,OMLA组未发现手术并发症;LA组右下腹戳孔感染1例,未发现其它并发症。结论:OMLA具有损伤小,康复快,并发症少和住院时间短的优点,治疗急、慢性阑尾炎较理想的微创手术方法。

Objective ： To explore the clinical significance of One-pore microlaparoscopic appendectomy. Methods： We compared clinical of One-pore microlaparoscopic appendectomy（Group OMLA,n= 53） with Laparoscopic appendectomy （Group LA, n = 65）, from January 2005 to March 2006,in respect of operative time,hemorrhage volume,recovery time of bowel movement,time to normal temperature, duration of hospital,and the period of pain disappear after Surgery. Results： All the operations were performed successfully. No conversions to open surgery were needed. There were no significant difference（t=0. 7434,P=0. 4587;t= 1. 4562,P=0. 1480） in the amount of blood loss and the length of postoperative hospital stay between the Group OMLA [（10. 9±2.5）mL; （2.54±1.5）d]and the Group LA[（11. 3±3.2）mL; （34±1.2）d]. Shorter time to the operative, normal temperature time, recovery time of bowel movement , and the period of pain disappear after surgery were achieved in the Group OMLA[（23. 58±8.07）rain; （29.0±8.3）h; （ 16.0±5.3）h; （39.0±12.9）h]rather than in the Group LA[（36.43±7.32）min; （41.0± 16.2）h;（29.0± 10.1）h; （56.0±21.2）h,with significant difference（t= 9. 0579,P=0. 0000;t=4. 8919,P =0.0000;t=8. 4639,P=0. 0000;t=5. 1144,P=0. 0000）. The follow-up period was from 7 days to 1.5 years with an average of 8 months. No one had incision infection in Group OMLA, 1 case had incision infection in Group. LA Conclusions：One-pore microlap aroscopic appendectomy has advantages of micro-invasion ,little blood loss ,rapid postoperative recovery, and short hospitalization. It is a safe and practical method of minimally invasive surgery for the treatment of appendectomy.