常规腹腔镜器械行单孔腹腔镜下阑尾切除术的相关研究

Study on single-incision laparoscopic appendectomy with conventional laparoscopic instruments

目的探讨常规腹腔镜器械行单孔腹腔镜下阑尾切除术(SILA)的可行性,并与传统三孔腹腔镜下阑尾切除术(LA)进行比较。方法回顾性分析2018年1月至2020年8月嘉兴市第二医院113例急性阑尾炎患者的临床资料。其中61例行传统三孔LA治疗(三孔LA组),52例行经脐SILA治疗(SILA组)。记录手术时间、术中出血量、手术并发症、住院时间和住院费用。术后6 h采用疼痛视觉模拟量表评估疼痛程度。术后第1天检测C反应蛋白(CRP)。术后随访1个月。结果两组患者均未发生中转手术,术中均未发生大出血和副损伤,术后未发生重度疼痛、严重切口感染、腹腔残余脓肿和切口疝等;SILA组患者瘢痕隐蔽,美容效果满意。两组手术时间、术中出血量、术后第1天CRP比较差异无统计学意义(P>0.05);SILA组术后6 h中度疼痛率、住院时间和医疗费用明显低于三孔LA组[15.38%(8/52)比34.43%(21/61)、(3.63±1.22)d比(4.31±1.38)d和(8802±1466)元比(9559±1617)元],差异有统计学意义(P<0.05或<0.01)。结论应用常规腹腔镜器械开展经脐SILA安全可行,瘢痕隐蔽,美容效果好,住院时间短且费用低。

Objective To study the feasibility for transumbilical single-incision laparoscopic appendectomy(SILA)with conventional laparoscopic instruments,and compare SILA with the traditional three-port laparoscopic appendicectomy(LA).Methods The clinical data of 113 patients with acute appendicitis from January 2018 to August 2020 in the Second Hospital of Jiaxing City were retrospectively analyzed.Among them,61 patients received traditional three-port LA(three-port LA group),52 patients received transumbilical SILA(SILA group).The operative time,intra-operative blood loss,surgical complications,length of hospital stay and hospitalization costs were recorded.Pain score 6 h after operation was assessed by visual analogue scale.C-reactive protein(CRP)on the first day after operation was detected.All patients were followed up for 1 month.Results In 2 groups,all patients did not suffered from the conversion to open operation or multi-port method,massive bleeding and accessory injury during the operation.Moreover,severe pain,severe incision infection,residual abdominal abscess and incisional hernia did not occur.Patients in SILA group had more hidden abdominal scars.there were no statistical differences in operative time,intra-operative blood loss and CRP on the first day after operation between 2 groups(P>0.05);the rate of moderate pain degree 6 h after operation,length of hospital stay and hospitalization costs in SILA group were significantly lower than those in three-port LA group:15.38%(8/52)vs.34.43%(21/61),(3.63±1.22)d vs.(4.31±1.38)d and(8802±1466)yuan vs.(9559±1617)yuan,and there were statistical differences(P<0.05 or<0.01).Conclusions The transumbilical SILA with conventional laparoscopic instruments is safe and feasible,the scar is more difficult to see,the cosmetic effect is much clearer,and the length of hospital stay is shorter.