| Objective: Laparoscopic appendectomy as an ideal alterative approach has been accepted widely for pediatric appendicitis.In recent years,single-site/single-incision laparoscopic appendectomy(SLA)has been known and introduced as a new technique,reduced incisional morbidities and optimized cosmesis in contrasted to conventional laparoscopic appendectomy.SLA is generally performed by using a transumbilical triport or periumbilical three ports,but also results in chopstick effect in operation due to closed distance among instruments.Although single-port laparoscopic assisted extracorporeal appendectomy has been described and reported as a more handy procedure for appendicitis in children,it presents some disadvantages compared with conventional LA,including risk of potential appendiceal damage and incisional contamination during the exteriorized appendix with inflammatory adhesive or gangrenous appendix,and is difficulty to be performed in children with abscess or retrocecal appendix.For this reason,the different hybrid laparoscopic techniques were applied to pediatric appendectomy and individualized surgical programs were developed.The effects of hybrid LA on the surgical intervention and stress were compared with conventional LA in order to evaluate the individualized application value of hybrid LA in pediatric appendectomy for providing a more precise and individualized treatment program in children with appendicitis.Methods:The clinical data of 121 children with appendicitis who received laparoscopic appendectomy were retrospectively studied in our department from January 2018 to December 2018.According to the different surgical strageties,the patients were divided into the control group with conventional three-trocar laparoscopic appendectomy and the individual group with different hybrid laparoscopic appendectomies.The operating time,estimated blood loss,postoperative defecating time,postoperative gastric tube indwelling time,postoperative feeding time,postoperative drainage tube indwelling time,postoperative stay and complication rate were compared between the two groups in total and in different lesions(complicated or uncomplicated appendicitis).The postoperative pain score in the two groups was quantitatively evaluated at 12 h after surgery.Changes in laboratory findings such as the white blood cell count,neutrophil percentage,high-sensitivity C-reactive protein,C-reactive protein,and procalcitonin in different time points of the two groups were analyed.A follow-up on scar's visibility and satisfaction was conducted 3 months after surgery.SPSS 19.0 was utilized for data statistic and analysis.Results:All patients in both groups were completed successfully according to their surgical strageties respectively and no conversions or death.All patients were diagnosed with appendicitis by pathological examination after surgery.Among them,uncomplicated appendicitis: 22 cases in the individualized group and 23 cases in the control group;Complicated appendicitis: 36 cases in the individualized group and 40 cases in the control group.There was no significant difference between the control group and the individualized group in terms of general data,pathological type and clinical symptoms(P>0.05).The two groups were comparable.1.Total perioperative indexIn general,there were no statistically significant differences between the individualized group and the control group in terms of operating time,estimated blood loss,postoperative defecation time,postoperative gastric tube indwelling time,postoperative feeding time,postoperative stay and incidence of complications(P>0.05).2.Uncomplicated appendicitis perioperative index(1)The estimated blood loss(EBL): EBL of individualized group(1.5±0.44ml)was significantly less than control group(2.04±0.54ml)(P=0.001).(2)The postoperative stay(PS):PS of individualized group(3.95±1.84 days)was significantly less than control group(5.57±1.88days)(P=0.006).(3)Other perioperative indicators: there were no significant differences between the two groups in operating time,postoperative defecation time,postoperative gastric tube indwelling time,and postoperative feeding time(P>0.05).No complications occurred in both groups.3.Complicated appendicitis perioperative indexIn complicated appendicitis,there were no statistically significant differences between the individualized group and the control group in terms of operating time,estimated blood loss,postoperative defecation time,postoperative gastric tube indwelling time,postoperative feeding time,postoperative stay and incidence of complications(P>0.05).4.Postoperative pain score at 12hAt 12 h after the operation of uncomplicated appendicitis,the pain score was 3.95±0.72 in the individualized group and 5.09±0.73 in the control group.Compared with the two groups,the pain score in the individualized group was significantly lower than that in the control group(P=0.000).At 12 h after the operation of complicated appendicitis,the pain score was 7.33±1.01 in the individualized group and 7.35±1.03 in the control group.Compared with the two groups,the pain score in the individualized group was slightly lower than that in the control group,but there was no statistical difference(P=0.956).5.Laboratory indicators(1)Individualized group1)White blood cell count at time point of 24 hours post-operationally was decreased compared with the pre-operation(P=0.036),it decreased at time point of 72 hours post-operationally compared with the time point of 24 hours post-operationally(P=0.002),and it decreased at time point of 72 hours post-operationally compared with the time point of pre-operation(P=0.000).2)The percentage of neutrophils at time point of 24 hours post-operationally was decreased compared with the pre-operation(P=0.021),it decreased at time point of 72 hours post-operationally compared with the time point of 24 hours post-operationally(P=0.000),and it decreased at time point of 72 hours post-operationally compared with the time point of pre-operation(P= 0.000).3)Hypersensitive C-reactive protein at time point of 24 hours postoperationally was increased compared with the pre-operation(P=0.012),it decreased at time point of 72 hours post-operationally compared with the time point of 24 hours post-operationally(P=0.000),and almost reached to preoperational level(P=0.206).4)C-reactive protein at time point of 24 hours post-operationally was increased compared with the pre-operation(P=0.010),it decreased at time point of 72 hours post-operationally compared with the time point of 24 hours post-operationally(P=0.000),and it decreased at time point of 72 hours post-operationally compared with the time point of pre-operation(P=0.034).5)Procalcitonin at time point of 24 hours post-operationally was increased compared with the pre-operation(P=0.004),it decreased at time point of 72 hours post-operationally compared with the time point of 24 hours post-operationally(P=0.000),and it decreased at time point of 72 hours post-operationally compared with the time point of pre-operation(P=0.012).(2)Control group1)White blood cell count at time point of 24 hours post-operationally was decreased compared with the pre-operation(P=0.000),it decreased at time point of 72 hours post-operationally compared with the time point of 24 hours post-operationally(P=0.000),and it decreased at time point of 72 hours post-operationally compared with the time point of pre-operation(P=0.000).2)There was no statistically significant difference between the percentage of neutrophils at time point of 24 hours post-operationally and the pre-operation(P=0.376),it decreased at time point of 72 hours post-operationally compared with the time point of 24 hours post-operationally(P=0.000),and it decreased at time point of 72 hours post-operationally compared with the time point of pre-operation(P=0.000).3)Hypersensitive C-reactive protein at time point of 24 hours post-operationally was increased compared with the pre-operation(P=0.048),it decreased at time point of 72 hours post-operationally compared with the time point of 24 hours post-operationally(P=0.000),and almost reached to preoperational level(P=0.100).4)C-reactive protein at time point of 24 hours post-operationally was increased compared with the pre-operation(P=0.011),it decreased at time point of 72 hours post-operationally compared with the time point of 24 hours post-operationally(P=0.000),and it decreased at time point of 72 hours post-operationally compared with the time point of pre-operation(P=0.128).5)Procalcitonin at time point of 24 hours post-operationally was increased compared with the pre-operation(P=0.016),it decreased at time point of 72 hours post-operationally compared with the time point of 24 hours post-operationally(P=0.000),and it decreased at time point of 72 hours post-operationally compared with the time point of pre-operation(P=0.129).6.The visibility and satisficing score of incision scars(1)The visibility of incision scars:The average score of crochet assisted hybrid operation was 2.65±0.93,the average score of conventional instrument two-site hybrid operation was 4.79±0.74,and the average score of conventional three-trocar operation was 5.83±0.97.Compared with the three types of operations,the crochet assisted hybrid operation had the least obvious scars,and the conventional three-trocar operation had the most obvious scar,with statistically significant difference(P=0.000).(2)The satisficing scores of incision scars: The average score of crochet assisted hybrid operation was 8.55±0.83,the average score of two-site hybrid operation was 8.39±0.83,and the average score of conventional three-trocar operation was 7.85±0.74.Compared with the three types of operation,the satisficing scores of incision scars in crochet assisted hybrid operation was the highest,while the satisficing scores in two-site hybrid operation was slightly lower than that in crochet assisted hybrid operation,but there was no statistical difference(P=0.529).The satisficing scores of incision scars in conventional three-trocar operation was the lowest,which was significantly different from the other two operations(P<0.01).Conclusion: The individualized stragety of hybrid laparoscopic appendectomy can significantly reduce the estimated blood loss and postoperative stay,reduce the surgical trauma stress and postoperative pain,and accelerate the postoperative recovery in children.In the follow-up of 3 months after surgery,the hybrid laparoscopic appendectomy 's incision scars were less obvious than the conventional three-trocar appendectomy,and the patients and their families were more satisfied with the incision in the hybrid surgery.This stragety is safe,reliable and effective for pediatric appendicitis,and has individualized application value compared with conventional three-trocar surgery. |
PDF Full Text Request