单孔腹腔镜结合阑尾悬吊治疗小儿阑尾炎临床疗效观察

Effectiveness and Safety of Single-port Laparoscopy Combined with Appendix Suspension in the Treatment of Appendicitis in Children

【目的】探讨单孔腹腔镜结合阑尾悬吊治疗小儿阑尾炎的临床疗效。【方法】回顾性分析2016年12月至2018年8月本院收治的230例阑尾炎患儿的临床资料,根据手术方法的不同将其分为观察组(行单孔腹腔镜结合阑尾悬吊治疗)和对照组(常规腹腔镜阑尾切除术)。比较两组手术一般情况(包括切口长度、手术时间、术中出血量等)及术后并发症发生情况。并分别于术后12、24、36、72 h时采用视觉模拟评分法(VAS)评估两组患儿的疼痛程度,并比较两组术前和术后1、7 d时两组患儿血清白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平。【结果】观察组切口长度、术中出血量、术后排气时间、住院时间、术后止痛药使用时间均低于对照组,手术时间长于对照组,差异均有统计学意义(P<0.05)。观察组术后12、24、36、72 h时疼痛VAS评分均显著低于对照组同时点,差异均有统计学意义(P<0.05)。术后1 d,两组血清IL-8、TNF-α水平均显著高于术前,术后7 d低于术前及术后1 d,且观察组术后1、7 d血清IL-8、TNF-α水平低于对照组,差异均有统计学意义(P<0.05)。两组患儿均未出现切口感染、皮下气肿、腹腔残余感染、粘连性肠梗阻、脐疝等并发症。【结论】应用单孔腹腔镜结合阑尾悬吊治疗小儿阑尾炎能明显减轻患儿机体炎症应激反应,具有创伤小、术后恢复快、术后并发症少等优势,且相对于传统腹腔镜阑尾切除术更具美观价值。

【Objective】To investigate the efficacy and safety of single-port laparoscopy combined with appendix suspension in the treatment of appendicitis in children.【Methods】A total of 230 children with appendicitis admitted to our hospital from December 2016 to August 2018 were divided into observation group(n=115)and control group(n=115).The observation group was treated with single-port laparoscopy combined with appendix suspension,while the control group was treated with routine laparoscopic surgery.The general conditions of operation(including incision length,operation time,intraoperative bleeding volume.)and the occurrence of complications were compared between the two groups.Visual analogue scale(VAS)was used at 12,24,36 and 72 hours after operation to evaluate the pain degree of the two groups.T he levels of serum inflam m atory stress factors(IL-8,TNF-α)were measured before operation and 1 and 7 days after operation.【Results】The general conditions of operation in the observation group were significantly better than those in the control group(except operation time,incision length,intraoperative bleeding volum e,postoperative exhaust time,hospitalization time,and the use time of analgesics after operation)(P<0.05).The VAS scores of pain in the observation group at 12,24,36 and 72 hours after operation were significantly lower than those in the control group at the same time point(P<0.05).The serum levels of IL-8 and TN F-alpha were significantly higher in the two groups at 1 day after operation than those before operation(P<0.05),and gradually decreased at 7 days after operation.The serum levels of IL-8 and TNF-alpha in the observation group were significantly lower than those in the control group at 1,7 days after operation(P<0.05).There were no short-term and long-term complications such as incision infection,subcutaneous em physem a,residual abdominal infection,adhesive intestinal obstruction and umbilical hernia in both groups.【Conclusion】Single-port laparoscopy combined with appendix suspension in the treatm ent of appendicitis in children is safe and feasible.It can significantly alleviate inflam mation stress reaction in children.It has advantages of less traum a,faster recovery and fewer complications after operation,and has more aesthetic value than traditional laparoscopic appendectomy.