经脐单孔腹腔镜、多孔腹腔镜及开腹结肠切除术的分析比较

Comparative study among transumbilical single-port laparoscopic,multi-port laparoscopic and open approach for colectomy

目的:比较经脐单孔腹腔镜与传统多孔腹腔镜及开腹结肠切除术手术效果。方法:回顾性分析2011年1月—2012年12月34例经脐单孔结肠切除术患者(单孔组)与同期22例传统多孔腹腔镜结肠切除术(多孔组)和70例开腹结肠切除术患者(开腹组)资料。比较各组围手术期指标、手术效果和生活质量。结果:3组患者一般临床资料差异无统计学意义(均P>0.05)。多孔组的手术时间明显长于单孔组与开腹组(均P<0.05),但后两组间差异无统计学意义(P>0.05);在失血量、切口长度、术后疼痛指数、排气时间、进流食时间、术后首次下床时间、术后住院时间等方面,单孔组和多孔组均优于开腹组(均P<0.05),但单孔组与多孔组间差异均无统计学意义(均P>0.05);3组间围手术期花费、术后并发症发生率及复发率差异均无统计学意义(均P>0.05);单孔组与多孔组术后对伤口的美容指数和身体自我感知指数均较开腹组高(均P>0.05),且单孔组美容满指数高于多孔组(P<0.05)。结论:腹腔镜结肠手术与开腹手术治疗效果相似,但具有微创、恢复快、对生活质量影响小等优势。就美容效果而言,单孔腹腔镜手术最佳。

Objective： To compare the surgical effects of transumbilical single-port laparoscopic, conventional multi-port laparoscopic and open approach for colectomy. Methods： The clinical data of 34 patients undergoing transumbilical single-port laparoscopic colectomy （single- port group） between January 2011 and December 2012 along with 22 patients receiving multi-port laparoscopic colectomy （multiport group） and 70 patients subjected to open colectomy （open surgery group） during the sameperiod were retrospectively analyzed. The perioperative variables, surgical effects and quality of life of the patients among the groups were compared. Results： The general clinical data showed no statistical significance among the three groups of patients （all P〉0.05）. The average operative time in multi-port group was significantly prolonged compared with single-port group or open surgery group （both P〈0.05）, which in latter two groups showed no statistical difference （P〉0.05）. The parameters that included intraoperative blood loss, length of incision, postoperative pain index, and time to flatus, liquid diet, and ambulation, as well as length of hospital stay in the single-port group and multi-port group were all superior to those in open surgery group （all P〈0.05）, but between single-port group and multi-port group, these parameters had no statistical significance （all P〉0.05）. There was no statistical difference in perioperative costs, incidence of postoperative complications and recurrence rate among the groups （all P〉0.05）. The cosmetic scale and self-perceived body-image scale in single-port group and multi-port group were significantly higher than those in open surgery group （all P〈0.05）, and the cosmetic scale in single-port group was also higher than that in multi-port group （P〈0.05）.Conclusion： Laparoscopic colectomy offers similar efficacy to open surgery with the advantages of minimal invasiveness, quick recovery and little effect on quality of life, and as for the cosmetic results, single-port approach is the best option.