腹腔镜二孔法与三孔法阑尾切除术的对比研究

目的探讨腹腔镜二孔法与三孔法阑尾切除术的临床应用指征。方法回顾性分析腹腔镜阑尾切除术(Laparoscopic Appendectomy，LA)的临床资料，比较二孔法与三孔法LA的手术时间、戳孔感染率。本组206例完成LA术，其中三孔法148例(9例由二孔法中转)、二孔法58例。结果平均手术时间二孔法显著短于三孔法(P=0．000)。急性单纯性阑尾炎和慢性阑尾炎LA术后戳孔均无感染，急性化脓性阑尾炎戳孔感染率二孔法与三孔法无显著性差异(P=1．000)，急性坏疽性阑尾炎戳孔感染率二孔法显著高于三孔法(P=0．039)。结论LA二孔法具有更加微创、美容的特点，可作为单纯性、化脓性及慢性阑尾炎的首选术式．但对于坏疽性阑尾炎则宜选择三孔法。

Comparative study on laparoscopic appendectomy with two-trocars and with three-trocars

Objective To investigate the operation indications of laparoscopic appendectomy(LA) with two-trocars and with three-trocars. Methods From Jan.2003 to July 2004,the clinical data of 206 cases with appendicitis received laparoscopic appendectomy were analyzed retrospectively.The operation time and the rate of wound infection of LA with two-trocars and with three-trocars were compared.Among 206 cases accepted LA, 58 cases operation were performed with two-trocars and 148 with three-trocars.Results The average operation time of two-trocars group was significant shorter than that of three-trocars group(P=0.000). In the case of acute simple appendicitis and chronic appendicitis,no wound infection was found after operation. The rate of wound infection of acute purulent appendicitis between two-trocars group and three-trocars group had no significant difference(P=1.000). The rate of wound infection of acute gangrenous appendicitis in two-trocars group was significantly higher than that in three-trocars group(P=0.039).Conclusion Two-trocars method of LA has a better minimally invasive and cosmetic than that the three-trocars method. It is first choice for simple,purulent and chronic appendicitis,but for the gangrenous appendicitis,it should be choice the three-trocars method.