腹腔镜下胆囊阑尾联合同孔切除术的临床分析

Clinical analysis of laparoscopic combined resection of the gallbladder and appendix

目的探讨腹腔镜下胆囊阑尾联合同孔切除术的安全性、可行性及临床效果。方法 2009年6月至2013年12月收治的68例胆囊良性病变合并慢性阑尾炎患者,随机分成三孔组和同孔组,每组34例。三孔组腹腔镜下胆囊阑尾联合经脐三孔切除术,同孔组腹腔镜下胆囊阑尾联合同孔切除术,分析和比较两组的临床治疗结果。选择SPSS16.0统计软件对所有研究数据进行处理,三孔组和同孔组平均手术时间、平均术中出血量、平均住院时间组间比较采用t检验,术后并发症发生率比较应用卡方检验,以P<0.05表示差异有统计学意义。结果三孔组和同孔组在平均手术时间、平均术中出血量、平均住院时间分别为(87.2±13.8)min比(64.3±9.5)min、(41.2±8.3)ml比(24.0±7.7)ml、(8.2±2.6)d比(4.1±1.8)d,两组比较发现同孔组明显优于三孔组,差异有统计学意义(t=2.776,2.998,2.571,P<0.05)。术后并发症,同孔组无有病例,三孔组有1例发生胆囊胆漏,差异无统计学意义。结论腹腔镜下胆囊阑尾联合同孔切除术,经一次手术同孔、同时处理两个疾病,减少了手术创伤,缩短了住院时间,临床效果满意。

Objective To study the safety,feasibility and clinical outcome of laparoscopic combined resection of the gallbladder and appendix. Methods From Junary 2009 to December 2013,68 patients with gallbladder benign lesions and chronic appendicitis were randomly divided into two groups：3-hole group（ 34 patients） and single-hole group（ 34）. Patients in the 3-hole group underwent the trans-umbilical laparoscopic resection of the gallbladder and appendix by using 3 Trocars,but in the single-hole group by using 1 Trocar. Clinical data of the two groups were analyzed using SPSS 16. 0 software,The average operation time,intraoperative blood loss and hospital stay were analyzed using Student＇s t test,and the incidence of complications was determined by the Chi-square test. A P value less than 0. 05 was considered statistically significant. Results The single-hole group was better than the 3-hole group in average operation time（ 87. 2 ± 13. 8） minutes vs（ 64. 3 ± 9. 5） minutes,intraoperative blood loss（ 41. 2 ±8. 3） ml vs（ 24. 0 ± 7. 7） ml and hospital stay（ 8. 2 ± 2. 6） days vs（ 4. 1 ± 1. 8） days（ t = 2. 776,2. 998,2. 571 respectively,P〈0. 05）. Postoperative complications showed no significant difference between the3-hole group and single-hole group,whereas there was 1 patient with gallbladder bile leakage in the 3-hole group. Conclusions Reduced surgical injury and shortened hospital stay could be achieved after combined laparoscopic resection of the gallbladder and appendix by using single-hole approach The clinical outcome of this operation was satisfactory.