经脐单一部位与常规腹腔镜阑尾切除术创伤反应的对比研究

A Comparative Study on Traumatic Reactions Between Laparoendoscopic Single-site and Traditional Laparoscopic Appendectomy

目的：比较经脐单一部位腹腔镜阑尾切除术（ laparoendoscopic single-site appendectomy ，LESS-LA）与常规三孔法腹腔镜阑尾切除术（ laparoscopic appendectomy ，LA）对机体的创伤反应。方法2011年4月～2013年3月选择205例成人急性阑尾炎，按掷硬币法分为2组，分别为LESS-LA组和常规LA组，比较2组手术时间，术前1 h，术后24、72 h血清白细胞介素6（interleukin-6，IL-6）、肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）、C 反应蛋白（C reaction protein，CRP）。结果LESS-LA组手术时间（50．3±10．8）min，明显长于常规LA组（26．1±8．8）min（t＝17．625，P＝0．000）。 LESS-LA组患者术前1 h，术后24、72 h血清IL-6分别为（8.41±1．51）、（35．65±3．36）、（25．29±3．25） pg／ml，常规LA组分别为（8．76±1．39）、（35．21±3．19）、（25．56±3．19） pg／ml，2组比较均无统计学差异（ t＝-1．728，P＝0．086；t＝0．962，P＝0．337；t＝-0．600， P＝0．549）；LESS-LA组患者术前1 h，术后24、72 h血清TNF-α分别为（14．47±2．05）、（27．43±2．61）、（20．01±3．13） pg／ml，常规LA组分别为（14．65±2．09）、（27.36±2．63）、（20．57±3．18） pg／ml，2组差异均无显著性（t＝-0．622，P＝0.535；t＝0.191，P＝0．849；t＝-1．270，P＝0.206）；LESS-LA组患者术前1 h，术后24、72 h血清CRP分别为（18．47±2．71）、（45．59±3．07）、（32．46±3．22） mg／L，常规LA组分别为（18．34±2．52）、（45．03±3．16）、（32．61±3．13） mg／L，2组差异均无显著性（t＝0.356，P＝0．722；t＝1．286，P＝0.200；t＝-0．338，P＝0．736）。结论与常规三孔法LA比较，LESS-LA切口美观，瘢痕几乎不可见，但手术时间显著延长，且手术创伤并未减少。

Objective To compare the traumatic reactions between laparoendoscopic single-site appendectomy （ LESS-LA） and traditional laparoscopic appendectomy （ LA） in the treatment of acute appendicitis . Methods A total of 205 patients with acute appendicitis from April 2011 to March 2013 were enrolled into this study .The patients were randomly divided into two groups using coin toss methods , receiving either LESS-LA or LA, respectively .The duration of the procedure , as well as serum levels of IL-6、TNF-α, and CRP at 1 hour preoperatively and at 24 and 72 hours postoperatively were compared between the two groups . Results The duration of the procedure was significantly longer in the LESS-LA group than that in the LA group [（50.3 ±10.8） min vs. （26.1 ±8.8） min, t=17.625,P=0.000].At 1 hour preoperatively and at 24 and 72 hours postoperatively, the serum levels of IL-6 were （8.41 ±1.51） pg/ml, （35.65 ±3.36） pg/ml and （25.29 ±3.25） pg/ml in the LESS-LA group, respectively, while （8.76 ± 1.39） pg/ml, （35.21 ±3.19） pg/ml, and （25.56 ±3.19） pg/ml in the LA group, without significant differences between the two groups （t=-1.728, P=0.086;t=0.962, P=0.337;t=-0.600, P=0.549）.The serum levels of TNF-αwere （14.47 ±2.05） pg/ml, （27.43 ±2.61） pg/ml, and （20.01 ±3.13） pg/ml in the LESS-LA group, respectively, while （14.65 ±2.09） pg/ml,（27.36 ±2.63） pg/ml, and （20.57 ±3.18） pg/ml in the LA group, respectively, without significant differences between the two groups （t=-0.622, P=0.535;t=0.191, P=0.849;t=-1.270, P=0.206）.The serum levels of CRP were （18.47 ±2.71） mg/L, （45.59 ±3.07） mg/L, and （32.46 ±3.22） mg/L in the LESS-LA group, and （18.34 ±2.52） mg/L, （45.03 ±3.16） mg/L, and （32.61 ±3.13） mg/L in the LA group, showing no significant differences （t=0.356, P=0.722;t=1.286, P=0.200;t=-0.338, P=0.736）. Conclusions The procedure of LESS-LA provides better cosmetic results.Compared with traditional LA, it demands much longer operating time .Traumatic reactions of these two procedures are comparable .