自制无菌手套软性Trocar经脐单孔腹腔镜阑尾切除术及医护配合的临床研究

Clinical Efficacy of Transumbilical Single-port Access Using Self-made Sterile Glove Soft Trocar Laparoscopic Appendectomy and Medical Cooperation

目的:探讨自制无菌手套软性Trocar经脐单孔腹腔镜阑尾炎切除术的安全性及疗效,总结手术配合方法。方法:对2015年1月-2016年1月110例急性阑尾炎病例按随机数字表法分为SSLA组50例,CLA组60例,比较两组临床疗效及总结手术配合经验。结果:全部患者均镜下完成,无中转开腹或增加穿刺孔,SSLA组患者术后肠道功能恢复早于CLA组,两组比较差异有统计学意义(P=0.0002)。但两组手术时间、术中出血量、术后住院时间、住院总费用及术中术后并发症比较差异均无统计学意义(P>0.05)。术后随访1~6个月,均未发现阑尾残株炎、阑尾残端瘘、肠粘连梗阻等远期并发症。结论:自制无菌手套软性Trocar经脐单孔腹腔镜阑尾切除术安全、有效,美容效果好,具有可行性,其临床应用价值仍需进一步的临床研究证实,良好的医护配合起到重要作用。

Objective：To investigate the safety and efficacy of transumbilical single-port access using selfmade sterile glove soft Trocar laparoscopic appendectomy and medical cooperation summary.Method：110 patients with acute appendicitis admitted to our hospital from January 2015 to January 2016 were divided into SSLA group of 50 patients and CLA group of 60 patients according to the random number table method.The clincal efficacy was compared between the two groups and sum up the experience of operation cooperation.Result：All the surgeries were completed under iaparoscopy,no case converted to laparotomy or additional trocar.Patients in the SSLA group recovery normal bowel activity earlier than those in the CLA group（P=0.0002）.However,the operation time,intraoperative bleeding amount,postoperative length of stay,total hospital costs,intraoperative and postoperative complication had no obviously statistical difference between two groups（P〉0.05）.Followed up for 1-6 months,no appendix stump inflammation,appendiceal stump fistula,adhesive intestinal obstruction or other remote complication appeared.Conclusion：Transumbilical single-port laparoscopic appendectomy access using self-made sterile glove soft Trocar is safe and feasible,while its clinical application needs further study,favorable medical cooperation plays an important role.