经脐单孔腹腔镜治疗小儿复杂性阑尾炎的疗效分析

Clinical experience of UOTLA in treatment of complicated appendicitis in children

目的分析经脐单孔腹腔镜术(UOTLA)治疗小儿复杂性阑尾炎的疗效。方法总结2012年1月-2015年10月在该院治疗的78例复杂性阑尾炎患者临床资料,其中单孔腹腔镜手术的44例患者为UOTLA组,开腹手术治疗的34例患者为开腹阑尾切除术组(OA),对两组患者的手术时间、术后住院时间、术后腹腔脓肿、切口感染、早期炎性肠梗阻和疼痛程度等指标进行统计分析。结果化验指标中C反应蛋白(CRP)在两组中无明显差异,外周血白细胞总数(WBC)在腹腔镜组下降较开腹组明显;手术相关指标中,UOTLA组手术时间较OA组缩短,但差异无统计学意义[(66.59±33.24)vs(72.86±30.36)min,P>0.05],术后住院时间更短[(8.21±1.67)vs(9.21±2.01)d,P<0.05]。术后腹腔脓肿UOTLA组3例,OA组1例(P>0.05);切口感染:UOTLA组6例,OA组9例(P>0.05);早期炎性肠梗阻:UOTLA组1例,OA组5例(P>0.05);疼痛程度比较,UOTLA组较OA组术后恢复正常活动时间明显缩短(P<0.05),UOTLA组的平均住院费用与OA组比较,差异无统计学意义[(10 639.37±2 970.92)vs(10 765.04±2 902.64)元,P>0.05]。结论 UOTLA治疗小儿复杂性阑尾炎不但具有创伤小、恢复快、住院时间短和美容效果等优点,而且并没有明显增加手术费用,术后并发症也没有明显增加,是一种安全有效的手术方式,可用于治疗小儿化脓穿孔性阑尾炎及坏疽穿孔性阑尾炎等相对复杂的阑尾炎。

Objective To analyze the efficacy of umbilical one trocar laparoscopic appendectomy(UOTLA)in treatment of complicated appendicitis in children.Methods Clinical data of78cases of children patients withcomplicated appendicitis from January2012to October2015was summarized,including44cases as UOTLA groupreceived umbilical one trocar laparoscopic appendectomy,34cases as OA group received open appendectomy.Thenstatistically analyzed all the patients’operation time,postoperative hospital stay,postoperative abdominal abscess,incision infection,early inflammatory intestinal obstruction and pain level.Results The laboratory test results ofC reaction protein(CRP)had no significant difference between the two groups,while peripheral white blood cellcount decreased more significantly in UOTLA group than that in OA group;the operation time of UOTLA groupwas shorter than that in OA group with no statistical difference[(66.59±33.24)vs(72.86±30.36)min,P>0.05],but postoperative hospital stay was shorter[(8.21±1.67)vs(9.21±2.01)d,P<0.05].Abdominal abscess after operation:3cases in UOTLA group,while1case in OA group(P>0.05);incision infection:6cases in UOTLAgroup,9cases in OA group(P>0.05);early inflammatory intestinal obstruction:1cases in UOTLA group,5cases in OA group(P>0.05);the pain level,postoperative recovery time was significantly shorter in UOTLAgroup compared with OA group(P<0.05).The average expenses comparison of the two groups has no statisticaldifference[(10639.37±2970.92)vs(10765.04±2902.64)yuan,P>0.05].Conclusion UOTLA is safe andeffective for complicated appendicitis in children due to minimally invasive,less pain and faster recovery withoutsignificant increase in the cost and postoperative complications.It can be applied in children with purulent,perforatedappendicitis and gangrene,perforated appendicitis and other complicated appendicitis.