经耻骨联合上单孔腹腔镜阑尾切除术  

Initial experience of single-incision laparoscopic appendectomy performed above the pubic symphysis

作　　者：余江[1] 王亚楠[1] 胡彦锋[1] 邓海军[1] 程侠[1] 甄莉[1] 李国新[1] 

机构地区：[1]南方医科大学南方医院,广东广州510515

出　　处：《腹腔镜外科杂志》2012年第8期611-613,共3页Journal of Laparoscopic Surgery

基　　金：广东省科技计划项目基金资助(编号:2006B12901006);广州市科技攻关项目基金资助(编号:2006Z3-E0571)

摘　　要：目的:探讨经耻骨联合上阴毛区域内单孔腹腔镜阑尾切除术的可行性。方法:2009年12月至2010年3月为6例患者(男5例,女1例)行经耻骨联合上单孔腹腔镜阑尾切除术。于耻骨联合上3～4 cm阴毛区域内做2 cm横切口,腹膜层三角分布置入一枚5 mm Trocar作为观察孔及两枚5 mm Trocar作为主副操作孔,采用常规腹腔镜器械施术。患者年龄分别为16、20、27、29、33、38岁。体重指数分别为18.07、19.27、21.67、18.34、26.83、22.46 kg/m2。术后随访均超过1个月,观察记录手术学指标、术后恢复指标及手术并发症。结果:6例患者均成功完成手术,无中转开腹或三孔法腹腔镜阑尾切除术。手术时间分别为55、58、47、51、42、33 min,术后肛门排气时间分别为25、24、22、18、7、10 h,术后住院时间分别为3、5、2、1、3、2 d。均无并发症发生。结论:初步临床经验表明,经耻骨联合上单孔腹腔镜阑尾切除术安全、可行,可完成局部粘连的较复杂阑尾切除术,达到术后隐蔽疤痕的美容效果,是值得进一步研究的单孔腹腔镜阑尾切除术的新入路。Objective：To evaluate the feasibility of single-incision laparoscopic appendectomy performed above the pubic sym- physis. Methods：From Dec. 2009 to Mar. 2010, six single-incision laparoscopic appendectomies above the pubic symphysis had been performed. During each operation, a 2 cm transverse incision was made in the pubic hair area 3-4 cm above the pubic symphysis, and af- ter cutting through the skin and subcutaneous fat, the linea alba was cut vertically. A 5 mm Trocar was then placed through the perito- neal layer as an observation port with other two 5 mm Trocars as main- and assisted-operating ports, arranged in a triangular distribu- tion. The Trocar above the observation port was slightly longer than those of the operating ports. The laparoscopic appendectomy was then performed using conventional laparoscopic instruments through this single-incisional access,and it could be said that abdominal proce- dures were similar to the three-port laparoscopic appendectomy. Follow-up of the patients were done at least one month, and the detailed operative parameters and post-operative recovery were recorded to assess the feasibility and safety of this novel procedure. Results ： Five male and one female patients （ aged 16,20,27,29,33 and 38 respectively ; body mass indexes were 18.07,19.27,21.67,18.34,26.83 and 22.46 kg/m2 ,respectively） underwent successful single-incision laparoscopic appendectomy above the pubic symphysis. No conver- sion to three-port laparoscopic appendectomy or open appendectomy occurred. Operating time was 55 rain, 58 min, 47 min, 51 rain ,42 rain and 33 min,the corresponding post-operative time to return bowel movement was 25 h,24 h,22 h,18 h,7 h and 10 h,while post- operative hospital stay was 3 d,5 d,2 d, 1 d,3 d and 2 d, respectively. No complications occurred during or after operation within the follow-up period. Conclusions .. The initial experiences imply the safety and feasibility of single-incision laparoscopic appendectomy per- formed above the pubic symphysis. The procedur

关 键 词：阑尾切除术 耻骨联合 腹腔镜检查 单孔 

分 类 号：R656.8[医药卫生—外科学]