经脐单切口与传统三孔腹腔镜阑尾切除术的回顾性对比研究

A Retrospective Comparative Study Between Transumbilical Single-incision and Traditional Three-port Laparoscopic Appendectomy

目的探讨经脐单切口腹腔镜阑尾切除术的安全性、可行性。方法回顾性分析2009年6月~2014年12月我科经脐单切口（189例）和三孔（123例）腹腔镜阑尾切除术的临床资料,均经临床表现、彩超或CT诊断为阑尾炎,排除病例资料不全、联合其他手术、妊娠期阑尾炎、急性阑尾炎发病超过72小时者。比较2组术中、术后资料。结果 2组均无中转开腹,经脐组与三孔组手术时间、术后排气时间、术后住院日差异无显著性[（45.5±12.7）min vs.（46.3±17.8）min,t=-0.461,P=0.650;（1.4±0.5）d vs.（1.5±0.6）d,t=-1.588,P=0.112;（3.8±1.6）d vs.（4.1±1.9）d,t=-1.554,P=0.121],经脐组术后3个月美容评分高[（4.5±0.6）分vs.（4.2±0.5）分,t=4.585,P=0.000],2组并发症发生率、病理类型等无统计学差异,其中经脐组切口感染3例,三孔组4例。结论经脐单切口腹腔镜阑尾切除术技术上安全可行,且美容效果较好。

Objective To discuss the safety and feasibility of single-incision laparoscopic appendectomy （SILA）. Methods A retrospective analysis was made on clinical data of patients diagnosed as having appendicitis by clinical manifestations, ultrasound or computer tomography at our department from June 2009 to December 2014. There were 189 cases of transumbilical SILA （transumbilical group） and 123 cases of traditional three-port laparoscopic appendectomy （three-port group）. Patients with incomplete records, combination with other surgery, pregnancy appendicitis, acute appendicitis over 72 hours were excluded. Intraoperative and postoperative data of two groups were compared. Results No conversion to open surgery was required in both groups. The operation time, postoperative exhaust time, and postoperative hospital stay had no significant differences between the transumbilical group and the three-port group [（45.5 ±12.7） rain vs. （46.3 ±17.8） rain, t= -0.461, P=0.650; （1.4 ±0.5） d vs. （1.5 ±0.6） d, t= -1.588, P=0.112; （3.8±1.6） d vs. （4.1±1.9） d, t= -1.554, P=0.121]. The cosmetic scores at3 months after surgery was higher in the transumbilical group than that in the three-port group [ （4.5 ±0.6） points vs. （4.2 ±0.5） points, t =4. 585, P = 0. 0001. No significant differences were identified in the incidence of complications and pathological types between the two groups. Conclusion SILA is technically feasible and safe with better cosmetic effects.