腹腔镜阑尾切除术阑尾根部3种处理方法的比较

Comparison among Three Approaches for Securing the Appendicular Stump during Laparoscopic Appendectomy

目的比较腹腔镜阑尾切除手术中分别应用3种不同方法处理阑尾根部:丝线结扎、塑料夹(Hem-o-lok)夹闭、圈套器(Endoloop)套扎的效果。方法 2010年2月～2011年8月168例因急性阑尾炎接受急诊腹腔镜阑尾切除术,采用3种不同方法处理根部:阑尾根部用丝线结扎50例(丝线组),用Hem-o-lok夹闭65例(Hem-o-lok组),用Endoloop套扎53例(Endoloop组),比较3组术中、术后情况。结果 3组术后并发症、术后住院时间无显著性差异(P>0.05)。丝线组手术时间(54.7±5.6)min,显著长于Hem-o-lok组(44.7±5.5)min(q=13.903,P<0.05)和Endoloop组(49.1±5.1)min(q=7.428,P<0.05)。丝线组手术费用(3285.2±55.4)元,显著多于Hem-o-lok组(3083.3±80.0)元(q=23.402,P<0.05),但显著少于Endoloop组(3646.5±50.8)元(q=39.957,P<0.05)。结论 3种处理阑尾根部的方法都是安全、有效的,但Hem-o-lok夹闭比丝线结扎和Endoloop套扎,更省手术时间和手术费用,并且更适合于初学者。

Objective To compare the postoperative outcomes of suturing, Hem-o-lok, and Endoloop ligation for securing the appendicular stump during laparoscopic appendectomy. Methods Totally 168 cases of acute appendicitis received laparoscopic appendectomy in our hospital from February 2010 to August 2011. The patients were divided into suturing （n --50） , H em-o-lok （n = 65） , and Endoloop ligation （n = 53 ） groups during the procedure. Results No difference existed in postoperative complications （P = 0. 686） and hospital stay （P = 0. 393 ） among the three groups. Suturing group showed significantly longer operation time than both Hem-o-lok and Endoloop groups （54.7±5.6） min vs. （44.7 ±5.5） min （q=13.903, P〈0.05）, and （49.1±5. 1） rain （q = 7. 428, P 〈 0.05 ） , respectively]. Endoloop group had highest surgical cost, which was significantly higher than that in the suturing group （3646.5 ±50.8） RMB vs. （3285.2±55.4） RMB, q=39.957, P〈0.051; while, the cost in the suturing group was significantly higher than that in Hem-o-lok group （3285.2 ± 55.4） RMB vs. （3083.3 ± 80.0） RMB, q = 23. 402, P 〈 0.053. Conclusions Suturing, Hem-o-lok, and Endoloop ligation are all safe and effective for securing the appendicular stump during laparoscopic appendectom. Hem-o-lok is more cost- and time-saving than Endoloop ligation and suturing, and is also a better choice for beginners.