经脐单孔与三孔法腹腔镜胆囊、阑尾联合切除的对比研究

A Comparative Study on Transumbilical Single-port and Three-port Laparoscopic Cholecystectomy and Appendectomy

目的：探讨经脐单孔腹腔镜胆囊、阑尾联合切除的安全性与有效性。方法回顾性分析2011年1月～2014年1月45例单一术者完成的单孔腹腔镜胆囊、阑尾联合切除术的资料，并与同期另一组术者进行的56例三孔法腹腔镜胆囊、阑尾联合切除进行对比分析。2组年龄、性别、体重指数及腹部手术史等差异无显著性（P＞0．05）。结果单孔组3例因胆囊三角显露不清改行三孔手术，1例术后创口脂肪液化，余无并发症发生。与三孔组相比，单孔组患者满意度高[（8．4±1．0）分vs．（7．7±1．0）分，t＝3．184，P＝0．002]，但手术时间长[（61．2±17．6） min vs．（51．7±16．2）min，t＝2．822，P＝0．006]。2组术中出血量、术后6～24 h疼痛程度、术后肠道恢复时间、术后住院时间及并发症的差异无显著性（P＞0．05）。结论经脐单孔腹腔镜胆囊、阑尾联合切除术安全有效，且术后患者整体满意程度高，但手术操作难度相对较大，手术时间长，有一定单孔腹腔镜手术经验的医师可以开展。

Objective To evaluate the safety and effectiveness of transumbilical single-port laparoscopic cholecystectomy and appendectomy （ TSPLCA） . Methods A retrospective analysis was conducted in 45 patients who received TSPLCA by single operator in our hospital from January 2011 to January 2014.The operative and postoperative effects of TSPLCA were compared with 56 cases of conventional laparoscopic cholecystectomy and appendectomy （ CLCA ） during the same period.There was no obvious statistical difference in patients’age, gender, BMI, and abdominal surgery history （P〉0.05）. Results In the TSPLCA group, conversions to CLCA were carried out in 3 cases because of unsatisfied exposure of the Calot’ s triangle.Fat liquefaction occurred in 1 patient.The rest of the patients experienced no complications.Although TSPLCA was superior to CLCA on the satisfactory degree of operative effects during one-week’s follow-up （8.4 ±1.0 vs.7.7 ±1.0, t=3.184, P=0.002）, the operative time was significantly longer in TSPLCA group than in CLCA group [（61.2 ±17.6） min vs.（51.7 ±16.2） min, t=2.822, P=0.006].And there was no significant difference between TSPLCA and CLCA in blood loss, post-operative pain, post-operative intestinal recovery time, post-operative hospital stay, and post-operative complications. Conclusions Transumbilical single-port laparoscopic cholecystectomy and appendectomy is safe and effective, having the advantage of high levels of overall satisfaction.But the operation is more difficult and the operative time is relatively long, suitable for proper patients in experienced hands.