目的:比较单孔腹腔镜阑尾切除术(single-port laparoscopic appendectomy,SPLA)与传统三孔法腹腔镜阑尾切除术(conventional laparoscopic appendectomy,CLA)治疗成人急性阑尾炎的安全性与有效性.方法:将2014年1月至2015年12月收治的160例急性阑尾炎患者按随机数字表法分组,其中SPLA组78例、CLA组82例,观察两组患者的疗效.结果:术后24 h患者疼痛评分[(3.4±2.1)vs.(3.3±1.9)]两组差异无统计学意义(P=0.892).术后3个月健康调查简表SF-36八个维度指标及总分差异无统计学意义(P>0.05).术后3个月两组患者切口美观度自评分[(8.2±1.1) vs.(7.4±1.4)]差异有统计学意义(P<0.001).SPLA组手术时间较CLA组长(P<0.001),中转率高(P=0.013).两组术后镇痛药使用率(P=0.619)、住院时间(P=0.680)及并发症发生率(P=0.425)差异均无统计学意义.结论:与常规腹腔镜阑尾切除术相比,SPLA治疗成人急性阑尾炎在切口美观度方面具有优势,术后疼痛、生活质量方面两种术式相当,但SPLA手术时间更长,且依赖于术者较高的腹腔镜操作技巧.%Objective:To compare the safety and efficacy of single-port laparoscopic appendectomy (SPLA) with conventional three-port laparoscopic appendectomy (CLA) for adult acute appendicitis.Methods:Between Jan.2014 and Dec.2015,a total of 160 adult patients with acute appendicitis were randomly assigned to SPLA group (78 cases) and CLA group (82 cases).Treatment outcomes were analyzed.Results:There was no significant difference in patients' 24 h pain score between SPLA group and CLA group [(3.4±2.1)vs.(3.3±1.9),P=0.892]).There were no significant differences in the SF-36 health survey (P>0.05).The patient-reported cosmetic scores were better in SPLA group [(8.2±1.1) vs.(7.4±1.4),P<0.001].Operation time in SPLA group was significantly longer than that in CLA group (P<0.001).Conversion rate of surgery in SPLA group was significantly higher (P=0.013).There were no significant differences in the analgesics required (P=0.619),hospital stay (P=0.680) and complication rate (P=0.425) between the two groups.Conclusions:SPLA for adult acute appendicitis is superior to CLA with regard to cosmetic outcomes,SPLA is comparable to CLA in postoperative pain and quality of life.However,adoption of SPLA will rely on the presence of better laparoscopic expertise,and it takes more time to accomplish this procedure.
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