Wieck Minna M, Hamilton Nicholas A, Krishnaswami Sanjay
Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, Oregon.
Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, Oregon.
J Surg Res. 2016 Jun 15;203(2):253-7. doi: 10.1016/j.jss.2016.04.033. Epub 2016 Apr 24.
For appendicitis, single-incision laparoscopic appendectomy (SIA) has been proposed as an alternative to 3-port appendectomy (3PA). However, there remains controversy regarding outcomes and cost of SIA. We sought to review our experience with these two techniques to identify differences in these factors.
The charts of children (0-17 y) who underwent appendectomy at a tertiary pediatric hospital from 2011-2014 were retrospectively reviewed. Appendectomy was either performed through traditional 3PA or SIA (laparoscopically assisted via externalization through an umbilical incision). Demographic data including age, body mass index, comorbidities, and gender were examined. Information on perforation, operative time and cost, length of stay, and infectious complications for both SIA and 3PA was identified. Data were analyzed using student t tests and chi square analysis.
A total of 337 patients underwent appendectomy (141 SIA and 197 3PA), 35.6% of whom (40 SIA, 80 3PA) had perforated appendicitis. For nonperforated appendicitis, SIA had significantly shorter operative times, decreased operative costs, and length of stay. However, these differences were not found for perforated appendicitis. Regardless of appendicitis severity, there was no difference in rates of wound infection, abscess, or readmission between the two techniques.
Our study suggests that SIA is a faster, more cost effective alternative than 3PA for acute appendicitis. SIA did not result in increased infection rates for acute or perforated appendicitis and can be considered an equivalent alternative to 3PA in the surgical management of appendicitis.
对于阑尾炎，单切口腹腔镜阑尾切除术（SIA）已被提议作为三孔阑尾切除术（3PA）的替代方法。然而，关于SIA的疗效和成本仍存在争议。我们试图回顾我们使用这两种技术的经验，以确定这些因素的差异。
回顾性分析2011年至2014年在一家三级儿科医院接受阑尾切除术的儿童（0 - 17岁）病历。阑尾切除术通过传统的3PA或SIA进行（通过脐部切口腹腔镜辅助外置）。检查人口统计学数据，包括年龄、体重指数、合并症和性别。确定SIA和3PA的穿孔情况、手术时间和成本、住院时间以及感染并发症的信息。数据采用学生t检验和卡方分析。
共有337例患者接受了阑尾切除术（141例SIA和197例3PA），其中35.6%（40例SIA，80例3PA）患有穿孔性阑尾炎。对于非穿孔性阑尾炎，SIA的手术时间显著缩短，手术成本和住院时间降低。然而，穿孔性阑尾炎未发现这些差异。无论阑尾炎严重程度如何，两种技术的伤口感染、脓肿或再入院率均无差异。
我们的研究表明对于急性阑尾炎，SIA是一种比3PA更快、更具成本效益的替代方法。SIA不会导致急性或穿孔性阑尾炎的感染率增加，在阑尾炎的手术治疗中可被视为3PA的等效替代方法。
