经脐皱襞三孔腹腔镜阑尾切除与麦氏点小切口阑尾切除对比性研究

Comparative study of laparoscopic appendectomy and microincision appendectomy with Maxwell's point

目的经自然孔道腔镜手术已成为腹腔镜外科领域研究热点之一,本研究探讨经脐皱襞三孔法行腹腔镜阑尾切除术可行性、安全性及疗效。方法选取我院在2012年8月~2016年8月期间收治阑尾炎患者共150例,随机分为对照组和观察组,对照组患者进行麦氏点小切口阑尾切除术,观察组患者进行经脐皱襞三孔腹腔镜阑尾切除,比较两组患者的手术时间、术后排气时间、术中出血量、住院时间以及术后并发症的发生情况。结果观察组患者术后排气时间和术中出血量均显著低于对照组患者,差异具有统计学意义(P<0.05),两组患者的手术时间和住院时间均无显著差异;观察组CD3^+、CD4^+、CD4^+/CD8^+比值均较同时段对照组显著升高(P<0.05);观察组患者术后并发症的发生率显著低于对照组,差异具有统计学意义(P<0.05)。结论采用自然孔道脐部三孔法行阑尾切除术,安全可行、相对传统开放手术具有不可比的美容效果,达到腹壁无痕,手术视野更开阔,腹腔清洗更方便,切口感染等并发症少,可以有效减少术中出血量和术后排气时间,降低术后并发症的发生率,术后患者恢复时间短等优势,值得临床推广应用。

Objective Natural orifice transluminal endoscopic surgery had become one of the hotspots in the field of laparoscopic surgery. This study explored the feasibility, safety and curative effect of laparoscopie appendectomy via umbilical folds in three-hole method. Methods 150 eases of appendicitis cured in our hospital from August 2012 to August 2016 were selected and randomly divided into control group and observation group. Patients in control group were treated with wheat＇s points small incision Appendix resection operation, and patients in observation group were treated with umbilical wrinkle fold three hole abdominal mirror Appendix resection. Surgery time, and operation Hou exhaust time, and operation in the bleeding volume, and hospital time and operation Hou complications of occurred situation of the two groups were compared. Results Exhaust time and intraoperative blood loss after operation in observation group were significantly lower than those in the control group, the difference was statistically significant （P 〈 0.05）. The operation time and hospital stay showed no significant difference between the two groups. The ratio of CD3, CD4^＋, CD4^＋ / CD8^＋ in observation group was significantly increased, compared with control group （P 〈 0.05）. The incidence of postoperative complications in observation group was significantly lower than that in eontrol group, the difference was statistically significant （P 〈 0.05）. Conclusion Natural ehannel umbilical department three hole method line Appendix resection operation is safe and feasible. Compared with traditional open surgery, it has a comparable beauty effect. Abdominal wall has no marks, surgery vision is more open, abdominal cleaning is more convenient, incision infection and other complications are less. It can effectively reduce operation in the bleeding volume and operation Hou exhaust time, reduce operation Hou complications of occurred rate. The operation Hou patients recovery time id short. It is worth clinical application.