Kim Ji Hoon, Kim Ho Young, Park Sung Kyun, Lee Jung Sun, Heo Dong Sik, Park Sang Wook, Lee Yoon Suk
Department of Surgery, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
Ann Surg. 2015 Dec;262(6):1054-8. doi: 10.1097/SLA.0000000000001064.
Currently single-incision laparoscopic appendectomy (SIL-A) has become an option for treating appendicitis. The aim of this study was to evaluate the safety and feasibility of SIL-A compared with conventional laparoscopic appendectomy (CL-A) on a large experimental cohort.
Several studies had reported the safety and technical feasibility of SIL-A, albeit with a limited number of study subjects.
A total of 2587 patients (1208 SIL-A and 1379 CL-A) who underwent laparoscopic appendectomy from May 2008 to April 2013 were studied retrospectively. The clinical characteristics and short-term operative outcomes of these patients were reviewed and analyzed.
There were more simple type appendicitis in the SIL-A group and more complicated type appendicitis in CL-A group (81.0% vs 74.7% and 19% vs 25.3%, P <0.001, respectively). The operative time (minutes) was similar between the 2 groups (40.1 ± 18.6 vs 38.8 ± 25.2, P = 0.154). However, on subgroup analysis, operative time for simple type appendicitis was longer in the SIL-A group (36.6 ± 14.9 vs 32.3 ± 18.3, P < 0.001). The superficial incisional surgical site infection rate was higher in the SIL-A group (4.4% vs 2.3%, P = 0.003). The readmission rate was higher in the CL-A group (0.8% vs 1.7%, P = 0.042). The postoperative hospital stay (days) was shorter in the SIL-A group (3.05 ± 1.97 vs 3.35 ± 2.14, P < 0.001).
In this study, SIL-A was technically feasible and safe option for appendicitis. The SIL-A group had more favorable outcomes such as shorter time to start diet and less hospital stay after surgery than the CL-A group. However, superficial incisional surgical site infection rate was higher in the SIL-A group than in the CL-A group, an effort to reduce superficial incisional SSI should be made.
目前，单孔腹腔镜阑尾切除术（SIL - A）已成为治疗阑尾炎的一种选择。本研究的目的是在一个大型实验队列中评估SIL - A与传统腹腔镜阑尾切除术（CL - A）相比的安全性和可行性。
已有多项研究报道了SIL - A的安全性和技术可行性，尽管研究对象数量有限。
回顾性研究了2008年5月至2013年4月期间接受腹腔镜阑尾切除术的2587例患者（1208例SIL - A和1379例CL - A）。对这些患者的临床特征和短期手术结果进行了回顾和分析。
SIL - A组单纯性阑尾炎较多，CL - A组复杂性阑尾炎较多（分别为81.0%对74.7%和19%对25.3%，P <0.001）。两组的手术时间（分钟）相似（40.1±18.6对38.８±25.2，P = 0.154）。然而，亚组分析显示，SIL - A组单纯性阑尾炎的手术时间较长（36.6±14.9对32.3±18.3，P <0.001）。SIL - A组浅表切口手术部位感染率较高（4.4%对2.3%，P = 0.003）。CL - A组再入院率较高（0.8%对1.7%，P = 0.042）。SIL - A组术后住院时间（天）较短（3.05±1.97对3.35±2.14，P <0.001）。
在本研究中，SIL - A在技术上是可行的，是治疗阑尾炎的安全选择。与CL - A组相比，SIL - A组有更有利的结果，如术后开始进食时间更短、住院时间更短。然而，SIL - A组浅表切口手术部位感染率高于CL - A组，应努力降低浅表切口手术部位感染。
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