摘要目的 评估朱氏置孔法腹腔镜阑尾切除术应用于复杂阑尾炎的安全性和有效性.方法 采用回顾性队列研究方法,分析2013年6月至2017年12月间在温州医科大学附属第一医院接受腹腔镜阑尾切除术的139例复杂阑尾炎患者的临床资料.术中采用朱氏置孔法59例(朱氏置孔组):脐孔10 mm作为镜孔,脐孔水平与右锁骨中线的交点处12 mm作为主操作孔;脐孔下方0～3 cm水平线与右腋前线之间的交点处5 mm为辅助操作孔,同时兼顾Douglas窝和右髂窝("双功能")的引流;主刀和扶镜手分立于患者右侧和左侧.术中采用传统三孔法80例(传统置孔组):脐孔下缘10 mm镜孔,左下腹直肌外侧缘10～12 mm主操作孔,耻骨上方5 mm辅助操作孔;主刀和扶镜手均位于患者左侧.比较两组患者手术时间、术后进食流质时间、术后住院时间、术后并发症发生率及住院费用等围手术期指标.结果 两组患者年龄、性别、术前体温、白细胞计数、中性粒细胞百分比、病理诊断及复杂类型等基线资料的比较,差异均无统计学意义(均P>0.05).朱氏置孔组患者中转开腹率较传统置孔组显著降低[0比10.0％(8/80),χ2=4.552,P=0.033].将中转开腹病例剔除后,朱氏置孔组和传统置孔组病例数分别为59例和72例.与传统置孔组相比,朱氏置孔组患者手术时间[(47.8±20.1)min比(66.0±27.3)min,t=4.383,P<0.001]、术后进食流质时间[(35.0±20.7)h比(59.3±32.8)h,t=5.158,P<0.001]和术后住院时间[(4.1±1.6)d比(5.5±2.2)d,t=4.162,P<0.001]缩短,术后总并发症[3.4％(2/59)比18.1％(13/72),χ2=6.879,P=0.009]、腹腔脓肿[0比11.1％(8/72),χ2=5.179,P=0.023]及麻痹性肠梗阻[1.7％(1/59)比12.5％(9/72),χ2=3.946,P=0.047]的发生率降低,住院费用减少[(13585±2909)元比(16861±5334)元,t=4.463,P<0.001].结论 朱氏置孔法腹腔镜阑尾炎切除术治疗复杂阑尾炎有效、可行并可达到快速康复和节约诊疗费用的效果.

abstractsObjective To evaluate the feasibility and efficacy of Zhu′s trocar placement (ZTP)&nbsp;in laparoscopic appendectomy (LA) in the treatment of complicated appendicitis. Methods Clinical data of 139 complicated appendicitis patients undergoing LA at the First Affiliated Hospital of Wenzhou Medical University from June 2013 to December 2017 were retrospectively analyzed. ZTP-LA group comprised 59 cases and its procedure was as follows: 10 mm umbilical trocar was used as lens port;12 mm trocar at crossing point of umbilical hole horizontal line and right midclavicular line was used as main operating port; 5 mm trocar at the crossing point of horizontal line 0-3 cm below umbilicus and right anterior axillary line was used as assist operating port with the drainage function for Douglas fossa and right iliac fossa; The operator and the assistant stood on the right side and the left side of the patient respectively. Traditional three-port group comprised 80 cases (8 cases converted to laparotomy, 72 cases enrolled finally) and its procedure was as follows:10 mm lens port below umbilicus;10-12 mm main operating port at lateral border of left lower rectus abdominis; 5 mm assist operating port above pubis; The operator and the assistant stood on left side of the patient. The operative time , time to oral semi-fluid, postoperative hospital stay, cost during hospitalization, and postoperative morbidity of complication were compared between two groups. Results Baseline data such as gender, age, WBC count, percentage of leukocyte, pathological finding and type were not significantly different between two groups (all P>0.05). The conversion rate in ZTP-LA was significantly lower than that in traditional three-port group [0％(0/59) vs. 10.0％(8/80),χ2=4.552,P=0.033]. Compared with traditional three-port group, ZTP-LA group showed shorter operative time [(47.8 ±20.1) minutes vs. (66.0±27.3) minutes, t=4.383,P<0.001], shorter time to oral semi-fluid [(35.0±20.7) hours vs. (59.3±32.8) hours, t=5.158,P<0.001], shorter postoperative hospital stay [(4.1±1.6) days vs. (5.5±2.2) days, t=4.162, P<0.001], lower postoperative morbidity of complication [3.4％ (2/59) vs. 18.1％(13/72),χ2=6.879, P=0.009], lower incidence of postoperative intra-abdominal abscess [0％(0/59) vs. 11.1％(8/72),χ2=5.179, P=0.023], lower incidence of paralytic ileus [1.7％(1/59) vs. 12.5％(9/72),χ2=3.946, P=0.047] and less cost during hospitalization [(13585 ±2909) yuan vs. (16861 ±5334) yuan, t=4.463, P<0.001]. Conclusion ZTP-LA is safe, feasible and effective with advantages of faster recovery and less cost in the treatment of complicated appendicitis.