非气腹单孔拖出式腹腔镜阑尾切除术与常规腹腔镜阑尾切除术的比较

目的 探讨非气腹单孔拖出式腹腔镜阑尾切除术的疗效.方法 2010年1月~2012年1月对93例慢性阑尾炎、急性单纯性阑尾炎分别施行非气腹单孔拖出式腹腔镜阑尾切除手术（单孔组,n=42）和常规腹腔镜阑尾切除术（常规组,n=51）,比较2组手术时间、术后排气时间、术后住院时间及费用.结果 单孔组8例为后位阑尾,无法单钳局部分离,改行传统腹腔镜下阑尾切除;常规组51例行传统腹腔镜下三孔阑尾切除术,无中转开腹.单孔组手术时间（26.1±3.2）min,显著短于常规组（47.1±4.4）min（t=-23.912,P=0.000）;单孔组术后恢复排气时间（12.1±2.1）h,显著短于常规组（20.1±1.9）h（t=-18.231,P=0.000）;单孔组术后住院时间（2.1±0.7）d,明显短于常规组（3.1±0.6）d（t=-7.039,P=0.000）;单孔组住院费用（5066.7±99.6）元明显少于常规组（5996.7±119.3）元（t=-37.543,P=0.000）.93例术后随访3～6个月,平均5.3月,均无并发症发生.结论 非气腹单孔拖出式腹腔镜阑尾切除术手术安全可行,与常规三孔法腹腔阑尾切除术相比,恢复快、费用少,切口瘢痕藏于脐部,美容效果更好.

Comparison between Gasless Single-port Pulling-out Laparoscopic Appendectomy and Conventional Laparoscopic Appendectomy

Objective To investigate the efficacy of gasless single-port pulling-out laparoscopic appendectomy （LA）. Methods From January 2010 to January 2012, 93 cases of appendicitis, including acute simple appendicitis and chronic appendicitis, underwent gasless single-port pulfing-out LA （single-port group, n = 42） or conventional three-trocar LA （conventional group, n = 51 ）. The operative time, postoperative exhaust time, postoperative hospital stay and hospital cost were compared between the two groups. Results In the single-port group, 8 cases were converted to three-port surgery because of retrocecal appendicitis and the rest operations were completed successfully. In the conventional group, all the operations were performed successfully without conversion to open surgery. Compared with the conventional group, the single-port group had significantly shorter operative time [（26.1±3.2）min vs. （47.1 ±4.4）min, t = -23.912,P=0. 000）],shorter postoperative exhaust time [（12.1 ±2.1）h vs. （20.1 ±1.9）h, t= -18.231,P=0.000], and shorter postoperative hospital stay [（2.1±0.7）dvs. （3.1 ±0.6）d, t= -7.039, P = 0. 000 ] ; the hospital cost of the single-port group was significantly lower than that of the conventional group [ （ 5066.7 ± 99.6 ） yuan vs. （5996.7± 119.3） yuan, t = - 37. 543,P = 0.000 ]. Ninety-three cases were followed up for 3 to 6 months （ average, 5.3 months） and no postoperative complications were observed. Conclusions Gasless single-port pulling-out LA is feasible and safe. Compared with conventional LA, it has faster recovery, lower hospital cost and better cosmetic effects due to incision scar being hidden in the umbilicus.