Baik Seung Min, Hong Kyung Sook, Kim Yong Il
Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea.
J Korean Surg Soc. 2013 Aug;85(2):68-74. doi: 10.4174/jkss.2013.85.2.68. Epub 2013 Jul 25.
Recently many cases of appendectomy have been conducted by single-incision laparoscopic technique. The aim of this study is to figure out the benefits of transumbilical single-port laparoscopic appendectomy (TULA) compared with conventional three-port laparoscopic appendectomy (CTLA).
From 2010 to 2012, 89 patients who were diagnosed as acute appendicitis and then underwent laparoscopic appendectomy a single surgeon were enrolled in this study and with their medical records were reviewed retrospectively. Cases of complicated appendicitis confirmed on imaging tools and patients over 3 points on the American Society of Anesthesia score were excluded.
Among the total of 89 patients, there were 51 patients in the TULA group and 38 patients in the CTLA group. The visual analogue scale (VAS) of postoperative day (POD) #1 was higher in the TULA group than in the CTLA group (P = 0.048). The operative time and other variables had no statistical significances (P > 0.05).
Despite the insufficiency of instruments and the difficulty of handling, TULA was not worse in operative time, VAS after POD #2, and the total operative cost than CTLA. And, if there are no disadvantages of TULA, TULA may be suitable in substituting three-port laparoscopic surgery and could be considered as one field of natural orifice transluminal endoscopic surgery with the improvement and development of the instruments and revised studies.
近来，许多阑尾切除术采用单切口腹腔镜技术进行。本研究的目的是明确经脐单孔腹腔镜阑尾切除术（TULA）与传统三孔腹腔镜阑尾切除术（CTLA）相比的优势。
2010年至2012年，89例被诊断为急性阑尾炎并由同一位外科医生进行腹腔镜阑尾切除术的患者纳入本研究，并对其病历进行回顾性分析。排除经影像学检查确诊为复杂性阑尾炎的病例以及美国麻醉医师协会评分超过3分的患者。
89例患者中，TULA组51例，CTLA组38例。TULA组术后第1天的视觉模拟评分（VAS）高于CTLA组（P = 0.048）。手术时间及其他变量无统计学意义（P > 0.05）。
尽管器械不足且操作困难，但TULA在手术时间、术后第2天之后的VAS以及总手术费用方面并不比CTLA差。而且，如果TULA不存在劣势，随着器械的改进和研究的修正，TULA可能适合替代三孔腹腔镜手术，并可被视为自然腔道内镜手术的一个领域。
