瘢痕隐藏式与传统腹腔镜阑尾切除术的对比研究

A Comparative Study Between Scar Hidden and Conventional Laparoscopic Appendectomy

目的探讨瘢痕隐藏式腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的应用价值。方法回顾性分析2011年7月~2016年6月107例瘢痕隐藏式LA(瘢痕隐藏组)和134例传统LA(传统组)的临床资料,比较2组手术时间、术中出血量、术后排气时间、疼痛评分、术后并发症、术后住院时间、美容评分。结果 2组患者均手术成功,无中转开放。瘢痕隐藏组术后并发症1例(切口感染1例),传统组术后并发症2例(切口感染1例,切口脂肪液化1例)。瘢痕隐藏组与传统组手术时间[(48.0±15.9)min vs.(45.2±11.5)min,t=1.585,P=0.114]、术中出血量[(12.9±8.4)ml vs.(14.0±10.7)ml,t=-0.870,P=0.385]、术后排气时间[(1.3±0.7)d vs.(1.3±0.5)d,t=0.000,P=1.000]、疼痛评分[(4.9±1.2)分vs.(5.2±1.5)分,t=-1.683,P=0.094]、术后并发症发生率[0.9%vs.1.5%,χ~2=0.000,P=1.000]、术后住院时间[(3.2±1.1)d vs.(3.5±1.4)d,t=-1.814,P=0.071]差异均无显著性,瘢痕隐藏组美容评分明显高于传统组[(4.4±0.6)分vs.(4.0±0.9)分,t=3.949,P=0.000]。结论瘢痕隐藏式腹腔镜阑尾切除术治疗急性阑尾炎安全可行,美容效果极佳。

Objective To explore the application value of scar hidden laparoscopic appendectomy （SHLA）. Methods A retrospectively analysis was made on clinical data of 107 patients underwent SHLA and 134 patients underwent conventional laparoscopic appendectomy （CLA） from July 2011 to June 2016. The operative time, operative blood loss, postoperative exhaust time, pain score, postoperative complications, postoperative hospital stay and cosmetic score were compared between the two groups. Results All the operations of both groups were successful without conversion to open surgery. There were 1 case of wound infection in the SHLA group and 1 case of wound infection and 1 case of incision fat necrosis in the CLA group. There were no significant differences in operative time [（48.0±15.9） min vs. （45.2±11.5） min, t =1.585, P =0.114], operative blood loss [（12.9±8.4） ml vs. （14.0±10.7） ml, t =-0.870, P =0.385], postoperative exhaust time [（1.3±0.7） d vs. （1.3±0.5） d, t =0.000, P =1.000], pain score [（4.9±1.2） points vs. （5.2±1.5） points, t =-1.683, P =0.094], postoperative complications [0.9% vs. 1.5%, χ 2 =0.000, P =1.000], and postoperative hospital stay [（3.2±1.1） d vs. （3.5±1.4） d, t =-1.814, P =0.071] between SHLA and CLA. The cosmetic score in the SHLA group was higher than that in the CLA group [（4.4±0.6） points vs. （4.0±0.9） points, t =3.949, P =0.000]. Conclusion SHLA is safe and feasible for acute appendicitis with favourable cosmetic results.