单孔与三孔腹腔镜胆囊阑尾联合切除术治疗急性阑尾炎合并胆囊结石的疗效比较

A Comparative Study on Effect of Combined Laparoscopic Cholecystectomy and Appendectomy with Single-Hole and Three-Hole in Treatment of Acute Appendicitis Complicated with Gallstone

目的比较单孔与三孔腹腔镜胆囊阑尾联合切除术治疗急性阑尾炎合并胆囊结石的临床效果。方法收集2016年1月至2018年1月北京市第二医院收治的80例急性阑尾炎合并胆囊结石患者的临床资料进行回顾性分析,依据治疗方法不同分为研究组和对照组,各40例。对照组采用三孔腹腔镜胆囊阑尾联合切除术治疗,研究组采用单孔腹腔镜胆囊阑尾联合切除术治疗。比较两组患者手术相关临床指标、手术前后生活质量评分、术后切口美观度以及并发症发生率。结果两组术中出血量比较差异无统计学意义(P>0.05),研究组患者手术时间、术后首次进食时间及平均住院时间均明显短于对照组[(49.0±6.0)min比(55.56±6.9)min、(18.7±4.4)h比(23.9±4.4)h、(2.2±0.7)d比(5.8±0.7)d](P<0.01)。各项生活质量指标手术前后与处理存在交互作用(P<0.05),研究组和对照组手术前后精神健康、躯体功能、生理功能、社会功能评分的变化幅度不同,两组术前各指标比较差异无统计学意义(P>0.05),研究组提高生活质量评分的效果优于对照组。研究组术后切口美观度评分高于对照组[(8.3±1.4)分比(7.2±1.2)分](P<0.01)。研究组术后无并发症发生,对照组并发症发生率为2.5%(1/40),两组并发症发生率比较差异无统计学意义(P>0.05)。结论单孔与三孔腹腔镜胆囊阑尾联合切除术治疗急性阑尾炎合并胆囊结石均有显著效果,与三孔腹腔镜胆囊阑尾切除术相比,单孔腹腔镜胆囊阑尾联合切除改善患者术后生活质量与切口美观度更显著。

Objective To compare the clinical effect of combined laparoscopic cholecystectomy and appendectomy with single-hole and three-hole for acute appendicitis with gallstones.Methods The clinical data of 80 patients with acute appendicitis and gallstones admitted to Beijing Second Hospital from Jan.2016 to Jan.2018 were collected for retrospective analysis.According to different treatment methods,they were divided into a study control group and a control group,40 cases each.The control group was treated with combined three-hole laparoscopic cholecystectomy and appendectomy,and the study group was treated with combined single-hole laparoscopic cholecystectomy and appendectomy.The clinical indicators,quality of life scores before and after surgery,beauty of postoperative incision and incidence of complications were compared between the two groups.Results There was no statistically significant difference in the amount of intraoperative bleeding between the two groups(P>0.05).The operation time,the first meal time and the average hospital stay of the study group were significantly shorter than those of the control group[(49.0±6.0)min vs(55.56±6.9)min,(18.7±4.4)h vs(23.9±4.4)h,(2.2±0.7)d vs(5.8±0.7)d](P<0.01).There were interactions between various quality of life indicators before and after surgery and treatment(P<0.05).The study group and the control group had different changing amplitudes in mental health,physical function,physiological function,and social function score before and after surgery.There was no statistical significance in different indexes between the two groups before surgery(P>0.05),while the effect of the study group on improving the quality of life score was better than that of the control group.The postoperative incision aesthetic score of the study group was higher than that of the control group(8.3±1.4 vs 7.2±1.2)(P<0.01).There was no postoperative complications in the study group,and the incidence of complications in the control group was 2.5%(1/40),there was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Both single-hole and three-hole laparoscopic cholecystectomy combined with appendectomy for acute appendicitis with gallstones have significant effects.Compared with three-hole laparoscopic surgery,single-hole laparoscopic surgery improves the quality of life and incision aesthetics of the patients more significantly.