Stanfill Amy B, Matilsky Danielle K, Kalvakuri Kavitha, Pearl Richard H, Wallace Lizabeth J, Vegunta Ravindra K
Department of Pediatric Surgery, Children's Hospital of Illinois, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA.
J Laparoendosc Adv Surg Tech A. 2010 Dec;20(10):873-6. doi: 10.1089/lap.2010.0147. Epub 2010 Sep 27.
Transumbilical laparoscopically assisted appendectomy (TULAA) has been reported in the literature as an alternative to traditional three-port laparoscopic appendectomy (LA). Our study compares outcomes between LA and the one-trocar transumbilical technique in a single institution over a concurrent time frame for all cases of pediatric appendicitis.
An Institutional Review Board-approved retrospective chart review of all appendectomies from July 2007 through June 2009 was performed. All appendectomies were performed either laparoscopically or transumbilically. One surgeon predominantly used the TULAA method, whereas the other 2 surgeons used strictly the LA method. No cases were converted to open. Categorization of specimens as normal, acute, or ruptured was based on pathology reports. Outcomes analyzed for each group included surgical duration, cost, length of stay, fever (>101.5F), wound infection, ileus, and postoperative abdominal-pelvic abscess.
A total of 131 appendectomies were performed by 3 surgeons, 83 were LA and 48 were TULAA. For all stages of appendicitis, outcomes differed significantly only for operating room cost, with the TULAA being significantly less expensive. All other outcomes were similar between the two techniques.
Our study suggests that TULAA is a reasonable alternative to the standard minimally invasive technique for appendicitis in both acute and ruptured situations. All analyzed complications were similar between the groups, suggesting that TULAA is an acceptable surgical method in pediatric patients for all stages of appendicitis.
文献报道经脐腹腔镜辅助阑尾切除术（TULAA）可作为传统三孔腹腔镜阑尾切除术（LA）的替代方法。我们的研究比较了在同一机构同时期内，针对所有小儿阑尾炎病例，LA与单孔经脐技术的手术效果。
对2007年7月至2009年6月期间所有阑尾切除术进行了机构审查委员会批准的回顾性病历审查。所有阑尾切除术均通过腹腔镜或经脐方式进行。一位外科医生主要采用TULAA方法，而另外两位外科医生则严格采用LA方法。所有病例均未中转开腹。标本分类为正常、急性或破裂依据病理报告。对每组分析的结果包括手术时长、费用、住院时间、发热（>101.5°F）、伤口感染、肠梗阻以及术后腹腔盆腔脓肿。
3位外科医生共进行了131例阑尾切除术，其中83例为LA，48例为TULAA。对于阑尾炎的所有阶段，仅手术室费用的结果有显著差异，TULAA的费用显著更低。两种技术的所有其他结果相似。
我们的研究表明，在急性和破裂情况下，TULAA是阑尾炎标准微创技术的合理替代方法。两组之间所有分析的并发症相似，表明TULAA在小儿患者阑尾炎的所有阶段都是一种可接受的手术方法。
