Single-port Laparoscopic Appendectomy versus Multiple-port Laparoscopic Appendectomy

急性闌尾炎分別在腹腔鏡單孔及多孔手術的比較

陳昱廷(Yu-Ting Chen) ； 蔡葵諺(Kuei-Yen Tsai) ； 王萬榆(Wan-Yu Wang) ； 沈士強(Shih-Chiang Shen) ； 廖立民(Li-Min Liao) ； 丘基泰(Kee-Thai Kiu) ； 顏珉玄(Min-Hsuan Yen) ； 張東晟(Tung-Cheng Chang)

《中華民國大腸直腸外科醫學會雜誌》 31卷2期 (2020/06) Pp. 67-74

https://doi.org/10.6312/SCRSTW.202006_31(2).10824

摘要

Background. The aim of this study was to present the results of first-tried cases of single-port laparoscopic appendectomy by a single surgeon at one institution. Materials and Methods. There were 52 patients with non-complicated acute appendicitis who were enrolled in this study. Patients were allocated into two separate groups to receive either single-port laparoscopic appendectomy (SPLA) or multiple-port laparoscopic appendectomy (MPLA) from November 2018 to April 2019. We compared operation times, conversion rates, overall complications, length of hospital stay, total wound lengths, and visual analog score (VAS score) for both groups. We also examined the learning curve for the surgeons in this study. Results. The SPLA group was younger than the MPLA group (31.5 ± 15.56 vs. 43.17 ± 16.52, p = 0.0160). Other demographic characteristics were not significantly different between both groups. There was no significant difference in average operation time between the SPLA group and the MPLA group (50.2 ± 11.1 vs. 51.4 ± 12.2 minutes). Both total wound length and postoperative date 1 (POD 1) VAS score were significantly lower in the SPLA group than in the MPLA group. The learning curves showed a trend toward a reduction in operation time across the three SPLA subgroups. Conclusions. Single-port laparoscopic appendectomy is a technically feasible and safe option for appendicitis. The number of cases of non-complicated acute appendicitis treated in our study suggests an achievable level of surgical skill required for SPLA. The SPLA group had some favorable outcomes: lower total wound length and reduced VAS score in postoperative date 1 in this study. Further studies should be conducted in complicated acute appendicitis cases.

關鍵字

Single-port ； Appendectomy ； Transumbilical ； Laparoscopy

並列摘要

背景：本篇研究是要探討在單一機構由單一位外科醫師進行首次多例腹腔鏡單孔闌尾切除手術的相關結果。研究來源與方法：從2018年11月至2019年4月，總共有52位非複雜性急性闌尾炎病人收案在本研究中。他們分配在腹腔鏡單孔與多孔兩個組別，並且比較兩組手術相關的結果。包含手術時間、術中由單孔轉成多孔、術後併發症、住院天數、傷口長度以及術後疼痛程度。也同時分析學習曲線。結果：兩個組別在術前的基本資料除了年紀有統計上的差異以外，其他因素都沒有差別。在術後的比較上，單孔手術的傷口長度與術後第一天的疼痛程度上明顯比多孔要短以及不痛。依照手術時間來看，顯示腹腔鏡單孔闌尾切除手術在本篇研究有達到克服學習曲線。結論：腹腔鏡單孔闌尾切除技術上來說是安全且可行的。從本篇研究來看，24個闌尾炎的案例足以讓之前沒單孔手術經驗的外科醫師達到技術上的成熟。腹腔鏡單孔闌尾切除手術提供傷口較小以及術後第一天比較不痛的好處。之後的研究要致力於增加複雜性闌尾炎在單孔手術的數量。

並列關鍵字

單孔 ； 闌尾切除 ； 經肚臍 ； 腹腔鏡

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