单孔腹腔镜在急腹症诊治中的应用(附34例分析)

Application of the single port laparoscopic surgery in the diagnosis and treatment of acute abdominal pain

目的:探讨单孔腹腔镜在急腹症诊治的应用。方法:2014年1月—2015年2月70例急腹症患者,其中传统组36例:传统腹腔镜胆囊切除术26例,传统腹腔镜阑尾切除术10例;单孔组34例:单孔腹腔镜胆囊切除术24例,单孔腹腔镜阑尾切除术10例。对比两组手术时间、术中出血量、术后排气时间和术后伤口美容效果。结果:70例急腹症患者均在腹腔镜协助下获得确诊,其中传统腹腔镜术漏诊10例在单孔腹腔镜下获得确诊,确诊率100%。腹腔胆囊切除术和腹腔阑尾切除术的手术时间单孔组比传统组短(P<0.05);术中出血量和术后排气时间差异无统计学意义(P>0.05);传统组穿刺在腹部留下多个"十字型"和"一字型"的切口瘢痕,美容效果差;单孔腹腔镜切口小,可吸收线缝合被褶皱掩饰的很好,美容效果比传统组更好。结论:单孔腹腔镜对急腹症诊治的安全性高,可行性强,临床以手术时间短和术后美容效果好。

Objective： To explore the application of the single port laparoscopic surgery in the diagnosis and treatment of acute abdominal pain. Methods： A retrospective study on 70 patients with acute abdominal pain treated in our department of hepatobiliary surgery of our hospital from January 2014 to Feburary 2015, including 50 patients with laparoscopic cholecystectomy and 20 patients with laparoscopic appendectomy. Cases were divided into the conventional group（36 cases,including 26 cases of traditional laparoscopic surgery cholecystectomy and 10 cases of traditional laparoscopic appendectomy）and the singlepont group（34 cases, including 24 cases of single port laparoscopic cholecystectomy and 10 cases of single port laparoscopic appendectomy）. The operative time, intraoperative blood loss, the exsufflation time and the postoperative wound cosmetic effect were compared between the two groups. The clinical diagnosis and treatment of the two methods were analyzed. Results： 70 cases of acute abdomen were diagnosed assisted by laparoscopic, including 10 cases missed diagnosis in traditional laparoscopic surgery, making the rate of diagnosis100%. The operating time for laparoscopic cholecystectomy and laparoscopic appendectomy of the single-hole group is shorter that of traditional group（P〈0.05）. Intraoperative blood loss and the exsufflation time of the two groups had no statistical significance（P〉0.05）. Multiple puncture cannulas in the traditional operation leave multiple ＂cross scar＂ and ＂linear scar＂, whose cosmetic result poor,while the single port laparoscopic surgery leaves small incision, absorbable thread can be hidden well by the umbilical fold, bringing much better cosmetic result（P〈0.05）. Conclusion： The diagnosis and treatment of Single port laparoscopic surgery owns high safety and strong feasibility. It is popular among patients for its shorter operating time and better postoperative cosmetic result with no scar,which is good for clinical application.