经脐单孔腹腔镜阑尾切除术在急性复杂性阑尾炎治疗中的有效性及安全性分析:一项单中心、回顾性研究

Efficacyy and safety of transumbilical single-incision laparoscopic appendectomyy foraacute complicated appendicitis:a singlecenter,retrospective study

目的探讨经脐单孔腹腔镜阑尾切除术(SILA)在急性复杂性阑尾炎治疗中的有效性及安全性。方法我院普外科2014年4月~2022年8月急诊行腹腔镜阑尾切除术(LA)的复杂性阑尾炎病人1104例,其中行SILA788例,传统三孔LA316例,比较两组手术时间、术中出血量、术后第1天白细胞数值、术后排气时间、住院时间、术后病理及术后并发症发生情况。结果SILA组手术时间(68.26±22.29)分钟、术中出血量(15.93±13.10)ml、术后排气时间(2.29±0.52)天、术后第1天白细胞(11.12±1.67)×10^(9)/L;LA组手术时间(66.47±20.40)分钟、术中出血量(16.65±12.98)ml、术后排气时间(2.23±0.58)天、术后第1天白细胞(11.35±1.54)×10^(9)/L,两组比较差异均无统计学意义(P>0.05)。术后随访1个月,两组均无切口疝等并发症;SILA组病人腹部切口美容效果满意;SILA组住院时间(4.60±1.18)天,少于LA组的(4.93±1.71)天,差异有统计学意义(P<0.05)。结论在熟练掌握LA操作的基础上,SILA安全可行,其除有瘢痕隐蔽美观功能外,并不延长手术时间、增加术后并发症风险。

Objective To investigate the efficacy and safety of transumbilical single-port laparoscopic appendicectomy in acute complicated appendicitis.Methodss Retrospective analysis was conducted for the data of 1104 patients with complicated appendicitis who underwent emergency laparoscopic appendectomy at the Department of General Surgery of Aerospace Center Hospital from April 2014 to August 2022;among them,788 patients underwent transumbilical single-port laparoscopic appendectomy(SILA)and 316 cases underwent traditional three-port laparoscopic appendectomy(LA);the operation time,intraoperative blood loss,leukocyte value on the first day after surgery,postoperative exhaust time,hospital stay,postoperative pathology and postoperative complications were statistically analyzed.Results The surgical duration of the single hole laparoscopic appendectomy(SILA)group was(68.26±22.29)minutes,intraoperative blood loss was(15.93±13.10)ml,postoperative exhaust time was(2.29±0.52)days,and white blood cells were(11.12±1.67)×10^(9)/L on the first day after surgery,and the surgical duration of the hree hole laparoscopic appendectomy(LA)groupwas(66.47±20.40)minutes,intraoperative blood loss was(16.65±12.98)ml,postoperative exhaust time was(2.23±0.58)days,and white blood cells were(11.35±1.54)×10^(9)/L on the first day after surgery,there was no statistically significant difference in the data between each group(P>0.05).After 1 month of follow-up,no incisional hernia and other complications occurred in the two groups,the cosmetic effect of abdominal incision in SILA group was satisfactory,the hospitalization time of SILA group was(4.60±1.18)days,which was shorter than that in the traditional LA group(4.93±1.71)days,and the difference was statistically significant(P<0.05).Conclusion Based on proficiency in traditional LA operations,SILA is safe and viable;in addition to the hidden aesthetic function of scars,it does not prolong the operation time and increase the risk of postoperative complications.