经脐单部位切口和传统腹腔镜治疗婴儿幽门狭窄的比较

Comparative Study Between Transumbilical Single-site Laparoscopic Pyloromyotomy and Conventional Laparoscopic Pyloromyotomy

目的探讨经脐和传统三孔腹腔镜手术治疗婴儿肥厚性幽门狭窄的疗效。方法回顾性分析我院2013年3月~2014年7月开展的腹腔镜幽门切开术76例资料,其中经脐组33例（在脐缘放置3个trocar）,传统三孔组43例。比较2组手术时间、术中出血量、术后住院时间及并发症等指标,术后1个月采用温哥华瘢痕评定量表进行评分。结果 76例手术均获成功,术后无并发症发生,2组住院时间、术中失血、术后并发症等差异无显著性。经脐组手术时间长[（40.3±20.2）min vs.（26.4±15.8）min,t=3.272,P=0.002],但瘢痕评分明显优于传统组[（2.9±2.7）分vs.（5.1±3.2）分,t=-3.256,P=0.001]。结论经脐单一部位切口腹腔镜幽门括约肌切开术安全可行,瘢痕隐蔽,值得在临床推广。

Objective To compare the therapeutic effects between transumbilical single-site laparoscopic pyloromyotomy and three-port laparoscopic pyloromyotomy . Methods Clinical data of 76 patients who were admitted into our hospital and undergone either single-site laparoscopic pyloromyotomy （ n=33 ） or three-port laparoscopic pyloromyotomy （ n=43 ） in the period from March 2013 to July 2014 were reviewed.Their operation time, blood loss, hospital stay after operation , and complications rate were analyzed . At the first month after surgery , the Vancouver scar assessment scale was used for evaluation . Results All the operations in 76 cases were successful.No postoperative complications occurred in both groups .The hospital stay, blood loss, and complications rates had no significant differences between the two groups .The operation time was longer in the single-site group than in the three-port group [（40.3±20.2） min vs.（26.4 ±15.8） min, t=3.272, P=0.002].However, the single-site group was superior to the three-port group in surgical scar scores [（2.9 ±2.7） points vs.（5.1 ±3.2） points, t=-3.256, P=0.001]. Conclusion Single-site laparoscopic pyloromyotomy is safe and effective with good cosmetic outcomes , being worthy of popularizing in clinical practice .