经脐体外腹腔镜辅助阑尾切除术

Transumbilical extracorporeal laparoscopic-assisted appendectomy.

作者信息

Perea Lindsey, Peranteau William H, Laje Pablo

机构信息

Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.

出版信息

J Pediatr Surg. 2018 Feb;53(2):256-259. doi: 10.1016/j.jpedsurg.2017.11.012. Epub 2017 Nov 13.

DOI:10.1016/j.jpedsurg.2017.11.012

PMID:29223668

Abstract

AIM OF THE STUDY

The perfect balance between safety, cosmesis, and cost effectiveness in a world with ever growing healthcare costs has yet to be found for nonperforated appendicitis. The aim is to present our data regarding safety and cost effectiveness of the transumbilical extracorporeal laparoscopic-assisted appendectomy technique.

METHODS

A retrospective review was performed for all laparoscopic appendectomies for acute appendicitis from October 2014 to October 2016. All cases of perforated appendicitis were excluded (visible hole/abscess/free pus). Included cases were divided into two groups by operative technique: transumbilical (TU) or laparoscopic 3-port (L3P). Operating room charges were billed in 30-min intervals, and hospital charges billed per night in-house. The technique was that the appendix is identified with the laparoscope, grabbed with a grasper that is inserted parallel to the laparoscope, and exteriorized through the umbilicus. The appendectomy is completed extracorporeally.

RESULTS

A total of 494 cases of nonperforated appendicitis were included in the study. One surgeon attempted all cases with the TU technique (n=161), and all other surgeons used the L3P technique (n=333), which required an endostapler and a vascular sealing device. The TU technique was successful in 99 of the attempted cases. The mean operative time of the TU cases and the L3P cases was 21 (8-43) and 37 (12-73) min, respectively (P<0.001). The mean hospital stay for the TU and the L3P cases was 1.6 (1-5) days (one-night admission) and 2.4 (1-14) days (two-night admission), respectively (P<0.001). There were no operative complications or readmissions in either group. The overall cost of the L3P cases was 30% higher than the cost of the TU cases.

CONCLUSION

The transumbilical extracorporeal laparoscopic-assisted technique was as safe as the laparoscopic 3-port technique. It offered all the advantages of a minimally invasive procedure, was associated with a significantly shorter hospital stay, and was remarkably more cost effective than the standard laparoscopic 3-port technique.

LEVEL OF EVIDENCE

III.

摘要

研究目的

在医疗成本不断增长的背景下，对于非穿孔性阑尾炎，尚未找到安全、美容效果和成本效益之间的完美平衡。本研究旨在展示我们关于经脐体外腹腔镜辅助阑尾切除术技术的安全性和成本效益的数据。

方法

对2014年10月至2016年10月期间所有急性阑尾炎腹腔镜阑尾切除术病例进行回顾性分析。所有穿孔性阑尾炎病例（可见穿孔/脓肿/游离脓液）均被排除。纳入病例根据手术技术分为两组：经脐（TU）组或腹腔镜三孔（L3P）组。手术室费用按30分钟间隔计费，住院费用按每晚住院计费。该技术是通过腹腔镜识别阑尾，用与腹腔镜平行插入的抓钳抓取阑尾，并通过脐部将其引出体外。阑尾切除术在体外完成。

结果

本研究共纳入494例非穿孔性阑尾炎病例。一名外科医生尝试了所有经脐技术病例（n = 161），所有其他外科医生采用腹腔镜三孔技术（n = 333），该技术需要使用吻合器和血管封闭装置。经脐技术在161例尝试病例中有99例成功。经脐组病例和腹腔镜三孔组病例的平均手术时间分别为21（8 - 43）分钟和37（12 - 73）分钟（P < 0.001）。经脐组和腹腔镜三孔组病例的平均住院时间分别为1.6（1 - 5）天（住院一晚）和2.4（1 - 14）天（住院两晚）（P < 0.001）。两组均无手术并发症或再次入院情况。腹腔镜三孔组病例的总体费用比经脐组病例高30%。