经X-CONE单孔与传统腹腔镜脾切除术的对比研究

目的 比较经 X-CONE 单孔腹腔镜和传统多孔腹腔镜行脾切除的安全性及可行性.方法 分析 2012 年 4 月至 2013 年 9 月经 X-CONE 单孔腹腔镜脾切除 12 例（ A 组）,应用传统多孔腹腔镜脾切除 19 例（ B 组）.比较两组病例的手术时间、标本取出时间、术中出血量、术后镇痛指数 （ VAPS ）、术后肛门排气时间、术后引流时间、术后住院时间、术后并发症、住院费用、美容效果评分等,并对结果进行分析.结果 两组患者均成功完成手术,A 组无中转为传统腹腔镜和开腹手术病例,两组均无明显手术并发症.两组病例比较在术中出血量、术后镇痛指数（ VAPS ）、术后肛门排气时间、术后引流时间、术后住院时间、住院费用等方面无统计学差异.A 组病例手术时间（ 168.4 ± 67.7 ） min 明显长于 B 组手术时间（ 105.4 ± 21.7 ） min,差异有统计学意义（ t = 2.57,P ＜ 0.05 ）.而两组病例标本取出时间,A组（ 4.1 ± 1.1 ） min少于 B 组（ 9.9 ± 3.0 ） min,差异有统计学意义（ t = -4.91,P ＜ 0.01 ）.术后美容效果评分 A 组（ 7.9 ± 1.1 ）分优于 B 组（ 6.4 ± 1.0 ）分,差异有统计学意义（ t = 3.89,P ＜ 0.01 ）.结论经 X-CONE 单孔腹腔镜行脾切除的安全性和可行性与传统多孔腹腔镜相当,美容效果突出,为患者提供了另一个微创技术的选择.

Comparative study between X-CONE single port and conventional laparoscopic splenectomy

Objective To compare the safety and feasibility of X-CONE single port laparoscopic surgery versus conventional laparoscopic surgery in splenectomy. Methods From April 2012 to September 2013, 12 cases underwent X-CONE single port laparoscopic splenectomy （Group A）, and 19 cases underwent conventional four ports laparoscopic splenectomy （Group B）. The data of patient age, spleen size, BMI, operation time, time of remove spleen, blood loss, time of flatus, drainage time, post-operative pain score （VAPS）, post-operative hospital stay, fee of hospital , complication and score of cosmetic result were recorded and analyzed. Results All cases are successful in surgery, with no significant complication postoperatively, and no cases were transformed to open or conventional laparoscopic surgery in group A. There were no significant differences in patients＇ age, spleen size, BMI, blood loss, time of flatus, drainage time, post-operative pain score （VAPS）, post-operative hospital stay, fee of hospital and complication. The operation time was significantly longer in group A （168.4 -＋ 67.7）min than in group B （105.4± 21.7）rain （t = 2.57, P 〈 0.05）, The time of remove spleen was significantly less in group A （4.1 ± 1.1）rain than in group B （9.9 ± 3.0）min （t = -4.91, P 〈 0.01）. The score of cosmetic result postoperative was better in Group A （7.9 ± 1.1） than in Group B （6.4 ± 1.0）, the difference is significant （t = 3.89, P 〈 0.01）. Conclusion X-CONE single port laparoscopie splenectomy is a safe and feasible procedure like the conventional four-port laparoscopic splenectomy , and with a prominent cosmetic result.It provide another choice of minimally invasive technique for patients.