免机械臂辅助单人单孔腹腔镜阑尾切除术在复杂性阑尾炎中的应用分析  

Analysis of the application of single-port laparoscopic appendectomy without holder assistance in patients with complicated appendicitis

作　　者：吕昊润 李育玺 郭鹏[1] 王顺雷 王传林[1] 郭立民[1] 郭磊 刘佳阳 王伟琪 范骁宇 李智勇 Lv Haorun;Li Yuxi;Guo Peng;Wang Shunlei;Wang Chuanlin;Guo Limin;Guo Lei;Liu Jiayang;Wang Weiqi;Fan Xiaoyu;Li Zhiyong(Department of Emergency Surgery,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院急诊外科,北京100044

出　　处：《中华胃肠外科杂志》2025年第3期314-319,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：科技部国家重点研发计划(2023YFC2412005)。

摘　　要：目的 探索影响免机械臂辅助下单人单孔腹腔镜阑尾切除术(SSLA)在复杂性阑尾炎患者中的应用及其危险因素。方法 本研究采用观察性研究方法。SSLA手术适应证:(1)CT或超声结果提示急性阑尾炎,白细胞计数及C反应蛋白升高;(2)病程超过72h,规范抗感染治疗无效,且炎性反应未局限,手术以脓肿引流为主要目的 ,结合术中具体情况切除阑尾;(3)急性发作经保守治疗后病情稳定3个月以上;(4)反复发作的慢性阑尾炎。相对禁忌证:(1)心肺功能不全,全身麻醉手术及腹腔镜手术风险极高;(2)凝血功能严重障碍;(3)影像提示已形成阑尾周围脓肿,且抗感染治疗后病情稳定,炎性反应有局限趋势。回顾性收集2023年2一10月期间于北京大学人民医院急诊外科接受SSLA的106例复杂性阑尾炎患者临床资料,术前CT表现为阑尾粪石、周围脂肪模糊、腔内外积气渗液、阑尾周围脓肿、腹水和肠梗阻性阑尾炎。男性和女性各53例,年龄(41.4±17.4)岁。体质指数为(24.2±3.6)kg/m^(2),术前体温(37.3±0.9)℃,阑尾炎发病病程>3d者21例(19.8%),阑尾最大径(12.4±3.8)mm。观察手术疗效,并采用Logistic回归分析探讨影响阑尾切除术手术时长的相关因素,采用限制性立方样条(RCS)的逻辑回归模型探讨阑尾最大径和手术时长的非线性关系。结果 全组患者除1例中转开腹之外,其余均顺利完成SSLA,中位术中失血量10(1~100)ml,手术时间(65.4±31.7)min。术后第1和7天疼痛评分分别为(3.4±3.2)分和(1.5±1.7)分,术后未出现明显并发症;术后住院时间(3.5±1.5)d,恢复正常活动时间14(2~40)d。单因素和多因素分析结果显示,发病病程>3d(0R=5.19,95%CI:1.59~16.98,P=0.006)和C反应蛋白>10mg/L(0R=1.01,95%CI:1.00~1.02,P=0.003)是导致手术时长>60min的独立危险因素,而阑尾最大径并非影响手术时长的独立因素(0R=1.10,95%CI:0.97~1.25,P=0.119)。RCS分析结果显示,阑尾最大径与手术时间�Objective The aim of this study was to explore the risk factors that affect implementation of the innovative technique of single-incision laparoscopic appendectomy(solo-SLA)without assistance in patients with complicated appendicitis,the goal being improving surgical success rates and reducing the incidence of complications.Methods This was an observational study.Indications for solo-SLA surgery were as follows:(1)computed tomography or ultrasound findings suggestive of acute appendicitis,accompanied by a high white blood cell count and C-reactive protein concentration;(2)disease course exceeding 72 hours,standard anti-infection treatment ineffective,inflammatory reaction not localized,surgery mainly aimed at abscess drainage,and the appendix removed if indicated intraoperatively;(3)acute onset stabilized for more than 3 months after conservative treatment;and(4)recurrent chronic appendicitis.Relative contraindications comprised:(1)cardiopulmonary insufficiency,extremely high risk for general anesthesia for laparoscopic surgery;(2)severe coagulation dysfunction;and(3)imaging findings suggestive of formation of a peri-appendiceal abscess,stable after anti-infection treatment,and a tendency for the inflammatory reaction to localize.We retrospectively collected clinical data of 106 patients with complicated appendicitis who had undergone solo-SLA in the Department of Emergency Surgery,Peking University People's Hospital from February to October 2023.Preoperative computed tomography showed appendiceal fecaliths,blurring of the tissue surrounding fat,intra-and extra-luminal gas and exudate,peri-appendiceal abscess,ascites,and intestinal obstruction by appendicitis.The study cohort comprised 53 male and 53 female patients aged(41.4±17.4)years.The median body mass index was(24.2±3.6)kg/m^(2)and median preoperative body temperature(37.3±0.9)°C Appendicitis had been present for>3 days in 21 of the patients(19.8%)and the maximum diameter of the appendix was(12.4±3.8)mm.The efficacy of the surgery was assessed and logi

关 键 词：阑尾炎 复杂性 腹腔镜手术 单孔 阅阑尾切除术 

分 类 号：R656.8[医药卫生—外科学]