Farach Sandra M, Danielson Paul D, Chandler Nicole M
Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA.
J Pediatr Surg. 2015 Aug;50(8):1364-7. doi: 10.1016/j.jpedsurg.2014.11.030. Epub 2014 Nov 20.
Single-incision laparoscopic appendectomy (SILA) is an effective treatment for appendicitis in children. We report our experience with SILA, focusing on how surgeon experience may impact quality outcomes.
A retrospective review of patients who underwent SILA from August 2009 to November 2013 was performed. Patients were grouped by early experience, late experience without surgical trainees, and late experience with trainees and further stratified into simple and complex appendicitis.
SILA was performed on 703 patients with a mean age of 11.8±3.9years. Four hundred eleven (58.5%) patients were diagnosed with simple and 292 (41.5%) with complex appendicitis. There was a significant decrease in operative time between early and late groups for both simple and complex appendicitis. Following the introduction of surgical trainees, there was a significant increase in operative time compared to the late group for simple appendicitis. There were no significant differences in complication rates between any of the groups.
The adoption of SILA requires a significant learning curve even for the experienced laparoscopist with the potential for decreased operative times with experience. While there may be an increase in operative time with the introduction of trainees, this does not impact quality outcomes.
单孔腹腔镜阑尾切除术（SILA）是治疗儿童阑尾炎的一种有效方法。我们报告我们的SILA经验，重点关注外科医生经验如何影响质量结果。
对2009年8月至2013年11月期间接受SILA的患者进行回顾性研究。患者按早期经验、无外科住院医师的晚期经验和有住院医师的晚期经验分组，并进一步分为单纯性阑尾炎和复杂性阑尾炎。
703例患者接受了SILA，平均年龄11.8±3.9岁。411例（58.5%）患者诊断为单纯性阑尾炎，292例（41.5%）为复杂性阑尾炎。单纯性和复杂性阑尾炎的早期和晚期组之间手术时间均显著缩短。引入外科住院医师后，单纯性阑尾炎的手术时间与晚期组相比显著增加。各组之间并发症发生率无显著差异。
即使对于经验丰富的腹腔镜医师，采用SILA也需要一个显著的学习曲线，随着经验的增加手术时间有可能缩短。虽然引入住院医师可能会增加手术时间，但这并不影响质量结果。
