单孔腹腔镜在阑尾切除术中的应用

目的:分析经脐单孔腹腔镜阑尾切除术的可靠性及常见问题的处理方法。方法:回顾分析89例经脐单孔腹腔镜阑尾切除术患者的临床资料。结果:80例患者顺利行经脐单孔腹腔镜阑尾切除术,成功率89.9%,6例改为两孔法,3例改为三孔法;手术时间平均(42.12±12.86)min,术中出血量1~10 ml,平均(4.3±1.4)ml,术后应用快速康复外科理念,术后当天下床,早期恢复饮食,平均(16.0±5.45)h恢复肠道功能。平均住院(4.55±2.26)d。术中常见问题为:腹腔脓液积聚(18/89)、阑尾显露困难(8/89)、腹腔粘连(4/89)及残端处理困难(7/89)。术后随访1~29个月,平均(15.0±2.60)个月,均未出现继发出血、粘连性肠梗阻及切口感染等并发症,患者对术后美容效果及恢复情况满意。结论:经脐单孔腹腔镜阑尾切除术安全、有效,且具有很好的美容效果,腹部无可视切口,更容易被接受,体现了腹腔镜手术的优点,是治疗阑尾炎的理想术式。熟练掌握腹腔镜技术及合理选择手术患者是手术成功的关键。

The application of single-port laparoscopy in the appendectomy

Objective： To analyze the reliability and the methods of dealing with the common problems of the transumbilical single-port laparoscopic appendectomy. Methods： The clinical data of 89 patients who underwent transumbilical single-port laparoscopic appendectomy were retrospectively analyzed. Results： Eighty transumbilical single-port laparoscopic appendectomy were ultimately successful,the success rate was 89. 9%. 6 cases were converted to the 2-port method,3 cases to three-port method. The average operation time was（ 42. 12 ± 12. 86） min,intraoperative blood loss was 1-10 ml,with the average of（ 4. 3 ± 1. 4） ml. Fast track surgery was used after operation,ambulation was achieved on the operative day,diet recovered early,intestinal function recovered（ 16. 0 ± 5. 45） h after operation. The mean hospital stay was（ 4. 55 ± 2. 26） d. Intraoperative common problem included the accumulation of abdominal pus（ 18 /89）,the difficult exposure of appendix（ 8 /89）,abdominal adhesions（ 4 /89） and difficult processing of residual（ 7 /89）. Patients were followed up for 1-29 months,with an average of（ 15. 0 ± 2. 60） months,no secondary bleeding,adhesive intestinal obstruction or infection of incision occurred,patients were satisfied with the cosmetic effect and postoperative recovery. Conclusions： The transumbilical single-port laparoscopic appendectomy is safe and effective with excellent cosmetic effect,and no visible incision can be found at abdomen. This procedure is more likely to be accepted,embodies the advantages of laparoscopic surgery,is an ideal surgical treatment for appendicitis. Familiar with laparoscopy and the selection of reasonable surgical patients are the keys to successful operation.