悬吊辅助法经脐单孔腹腔镜阑尾切除术

目的：评价悬吊辅助法经脐单孔腹腔镜阑尾切除术（transumbilical single-port laparoscopic appendectomy,TUS-PLA）的可操作性、安全性、微创性及美容效果。方法：2007年3月至2009年10月为39例成年慢性阑尾炎患者行腹腔镜阑尾切除术（laparoscopic appendectomy,LA）。在难以完成拖出法TUSPLA时,利用Endoclose经腹壁悬吊配合带操作通道的同轴腹腔镜完成全腹腔内操作的TUSPLA。结果：8例（21%）行拖出法TUSPLA,手术时间平均18.5min;26例（67%）行悬吊辅助法TUSPLA,手术时间平均41min;5例（13%）行两孔法LA,手术时间平均52min。所有患者均于术后2~3d出院。无术后并发症发生,脐部疤痕不明显。结论：利用Endoclose经腹壁吊线辅助,多数LA可经单个1cm的脐部切口完成。其操作简便、安全,能获得更好的微创和美容效果。

Transumbilical single port laparoscopic appendectomy with the aid of suspension

Objective:A transabdominal sling suture was used to aid the procedure of transumbilical single-port laparoscopic appendectomy(TUSPLA).The feasibility,safety,minimal invasion and cosmetic result of the technique were evaluated.Methods:From Mar.2007 to Oct.2009,laparoscopic appendectomy(LA) was performed in 39 consecutive adult patients with chronic appendicitis.TUSPLA by exteriorizing the appendix through the umbilical incision was attempted first.When it was difficult to complete,a transabdominal sling suture conducted by an "Endoclose" needle percutaneously inserted from the right lower quadrant was used,and the TUSPLA with totally intracorporeal appendectomy was performed by a coaxial laparoscope with a working channel.Results:TUSPLA by exteriorizing the appendix through the umbilical incision was completed in 8(21%) patients with a mean operative time of 18.5min.TUSPLA with the aid of suspension was completed in 26(67%) patients with a mean operating time of 41min.In the left 5(13%) patients,a second port was required with a mean operating time of 52min.All the patients were discharged 2 or 3 days after the operation.No postoperative complications were encountered.Umbilical scar was well-concealed.Conclusions:With the aid of a trans-abdominal sling suture conducted by an "Endoclose" needle,most of the LA can be performed through a single 1cm umbilical incision.This procedure is simple,safe and further improves the minimal invasiveness and cosmetic result.