经脐部三孔法腹腔镜阑尾切除术的研究

目的探讨完全经脐部三孔法腹腔镜阑尾切除手术的可行性及美容效果。 方法958例急性阑尾炎患者随机分为完全经脐部三孔法腹腔镜组（研究组）479例和传统非全部经脐部三孔法腹腔镜组（对照组）479例。比较两组手术的临床指标及术后随访情况，并采用患者问卷方法评价美容效果。 结果两组手术均顺利完成。研究组和对照组手术时间分别为（48±2.2）min和（30±1.6）min（t=144.819，P<0.01），差异有统计学意义，而术中出血量分别为（15±2.9）ml及（15±2.2）ml，下床活动时间分别为（26±3.1）h及（26±2.1）h，术后肛门排气时间分别为（29±2.1）h及（29±1.6）h，住院时间分别为（3±0.5）d及（3±0.3）d，综合费用分别为（6 589±42）元及（6 591±41）元，差异均无统计学意义。随访时间为1.7~4.8年，两组均无切口感染；止痛药使用频率分别为16.7%（80/479）和17.7%（85/479），差异无统计学意义；患者美容满意度为优的比例分别占99.8%（478/479）和9.8%（47/479），差异有统计学意义（χ²=782.84，P<0.01）。 结论经脐部三孔法腹腔镜阑尾切除术具有安全可行、腹部美容效果佳等优点，可作为急性阑尾炎的有效治疗方式之一。

Clinical study of total transumbilical tract laparoscopic appendectomy

ObjectiveTo explore the feasibility and cosmetic effect of total transumbilical tract laparoscopic appendectomy. MethodsA total of 958 appendicitis patients were randomly divided into group A (study group) and group B (control group). In group A, 479 patients were treated with total transumbilical tract laparoscopic appendectomy. In group B, the other 479 patients were treated with traditional non-transumbilical tract laparoscopic appendectomy. The clinic effect and the followed-up result were compared. The cosmetic results were scored by the patients. ResultsThe operation was successfully performed in all 958 patients. The operating time in group A and B was (48±2.2) min vs (30±1.6) min (t=144.819, P<0.01), the blood loss was (15±2.9) ml vs (15±2.2) ml, the off bed time was (26±3.1) h vs (26±2.1) h, the anus exhausting time was (29±2.1) h vs (29±1.6) h, the hospital stay was (3±0.5) d vs (3±0.3) d, the cost of the operation was (6 589±42) yuan vs (6 591±41) yuan, and the rate of analgesics using was 16.7% vs 17.7%. All the patients were followed-up for 1.7 to 4.8 years (average 2.9 years). There was no incision infection between two groups. The cosmetic satisfaction rate in group A and B were 99.8% vs 9.8% (χ²=782.84, P<0.05). ConclusionTotal transumbilical tract laparoscopic appendectomy is safe with good cosmetic result. It is effective for the patients with acute appendicitis.