ﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ دوﭘﻮرت ﺗﮏﺑﺮش ﺑﻪ ﻋﻨﻮان ﺟﺎﯾﮕﺰﯾﻨﯽ ﺑﺮاي آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ ﺑﯿﻦﻧﺎﻓﯽ ﺗﮏ ﭘﻮرت

Single-Incision Two-Port Laparoscopic Surgery as A Substitute for Single-Port Trans-umbilical Laparoscopic Surgery: Patients who Underwent Laparoscopic Appendectomy Surgery

زﻣﯿﻨﻪ و ﻫﺪف: ﻣﺪﯾﺮﯾﺖ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ ﺑﯿﻤﺎري ﻫﺎ اﻣﺮوزه در ﺟﻮاﻣﻊ ﺟﻬﺎﻧﯽ ﺑﻪ ﻋﻨﻮان اﺳﺘﺎﻧﺪارد ﻃﻼﯾﯽ ﭘﺬﯾﺮﻓﺘﻪ ﺷﺪه اﺳﺖ. ﺑﺎ اﯾﻦ ﺣﺎل ﻫﻨﻮز ﻫﻢ ﭘﮋوﻫﺶ ﻫﺎي ﺑﺴﯿﺎري درﺑﺎره ﺷﯿﻮه ﻫﺎي ﻧﻮﯾﻦ ﺟﺮاﺣﯽ ﮐﻢ ﺗﻬﺎﺟﻤﯽ ﺑﻪ ﺟﻬﺖ دﺳﺘﯿﺎﺑﯽ ﺑﻪ ﺑﻬﺘﺮﯾﻦ روش ﺟﺮاﺣﯽ ﺑﺎ ﻣﻄﻠﻮب ﺗﺮﯾﻦ ﻧﺘﺎﯾﺞ ﭘﺲ از ﻋﻤﻞ ﺻﻮرت ﻣﯽ ﭘﺬﯾﺮد. ﻫﺪف از ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﻣﻘﺎﯾﺴﻪ ﻧﺘﺎﯾﺞ ﭘﺲ از اﻋﻤﺎل ﺟﺮاﺣﯽ آﭘﺎﻧﺪﮐﺘﻮﻣﯽ آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ ﺑﯿﻦ ﻧﺎﻓﯽ ﺗﮏ ﭘﻮرت و آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ دوﭘﻮرت ﺗﮏ ﺑﺮش ﺑﻮده اﺳﺖ. ﻣﻮاد و روش ﻫﺎ: از 77 ﺑﯿﻤﺎر ﮐﻪ در ﻃﻮل ﯾﮏ ﺳﺎل )اردﯾﺒﻬﺸﺖ 1396-1397( ﺗﺤﺖ اﻋﻤﺎل ﺟﺮاﺣﯽ آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ ﺑﯿﻦ ﻧﺎﻓﯽ ﺗﮏ ﭘﻮرت و آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ دوﭘﻮرت ﺗﮏ ﺑﺮش ﻗﺮار ﮔﺮﻓﺘﻪ اﻧﺪ، در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﮔﺬﺷﺘﻪ ﻧﮕﺮ اﺳﺘﻔﺎده ﺷﺪ. در ﮔﺮوه آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ دوﭘﻮرت ﺗﮏ ﺑﺮش، دو ﺗﺮوﮐﺎر 5 ﻣﯿﻠﯽ ﻣﺘﺮي ﺑﻪ ﺻﻮرت ﺑﯿﻦ ﻧﺎﻓﯽ ﻗﺮار داده ﺷﺪ و از ﯾﮏ ﻣﺤﻞ ﺳﻮراخ ﮐﺮدن دﯾﮕﺮ ﺑﺮاي اﺑﺰارﻫﺎي ﭼﭗ دﺳﺖ اﺳﺘﻔﺎده ﺷﺪ. وﯾﮋﮔﯽ ﻫﺎي دﻣﻮﮔﺮاﻓﯿﮏ، داده ﻫﺎي ﻋﻤﻞ و ﻧﺘﺎﯾﺞ ﭘﺲ از ﻋﻤﻞ ﮔﺮوه ﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از آزﻣﻮن ﻣﺮﺑﻊ- ﮐﺎي ﯾﺎ در ﺻﻮرت ﻟﺰوم ﺑﺎ آزﻣﻮن ﻓﯿﺸﺮ ﻣﻘﺎﯾﺴﻪ ﺷﺪ. از آزﻣﻮن ﺗﯽ ﺑﺮاي ﻣﻘﺎﯾﺴﻪ ﻣﯿﺎﻧﮕﯿﻦ ﻫﺎي دو ﮔﺮوه ﻫﺪف ﮐﻪ ﻣﺴﺘﻘﻞ از ﯾﮑﺪﯾﮕﺮﻧﺪ، اﺳﺘﻔﺎده ﺷﺪ. ﺳﻄﺢ ﻣﻌﻨﺎداري آزﻣﻮن ﻫﺎ ﺑﺮاﺑﺮ 0/05 در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﺗﺤﻠﯿﻞ ﻫﺎي آﻣﺎري ﺑﺎ اﺳﺘﻔﺎده از ﺳﺮور 5.1 SAS EG، ﻧﺴﺨﻪ 9/3 اﻧﺠﺎم ﺷﺪ SAS Institute Inc., Cary, NC, USA)(. ﯾﺎﻓﺘﻪ ﻫﺎ: ﻣﯿﺎﻧﮕﯿﻦ ﮐﻞ زﻣﺎن ﻋﻤﻞ ﮔﺮوه آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ دوﭘﻮرت ﺗﮏ ﺑﺮش ﺑﻪ ﻃﻮر ﻣﻌﻨﺎداري ﮐﻤﺘﺮ از ﮔﺮوه آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ ﺑﯿﻦ ﻧﺎﻓﯽ ﺗﮏ ﭘﻮرت ﺑﻮد )0/003 = P(. ﻣﯿﺎﻧﮕﯿﻦ زﻣﺎن ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ ﻧﯿﺰ در ﮔﺮوه آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ دوﭘﻮرت ﺗﮏ ﺑﺮش ﺑﻪ ﻃﻮر ﻣﻌﻨﺎداري ﮐﻤﺘﺮ ﺑﻮد )0/001 < P(. ﻣﯿﺎﻧﮕﯿﻦ ﺗﻌﺪاد ﻣﺴﮑﻦﻫﺎ ﭘﺲ از ﻋﻤﻞ در ﮔﺮوه آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ دوﭘﻮرت ﺗﮏ ﺑﺮش ﺑﻪ ﻃﻮر ﻣﻌﻨﺎداري ﮐﻤﺘﺮ از ﮔﺮوه آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ ﺑﯿﻦ ﻧﺎﻓﯽ ﺗﮏ ﭘﻮرت ﺑﻮد )0/002 = P(. ﻣﯿﺎﻧﮕﯿﻦ ﻃﻮل ﻣﺪت روزﻫﺎي ﺑﺴﺘﺮي ﭘﺲ از ﻋﻤﻞ در ﮔﺮوه آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ دوﭘﻮرت ﺗﮏ ﺑﺮش ﺑﻪ ﻃﻮر ﻣﻌﻨﺎداري ﮐﻤﺘﺮ از ﮔﺮوه آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ ﺑﯿﻦ ﻧﺎﻓﯽ ﺗﮏ ﭘﻮرت ﺑﻮد )0/008 = P(. ﻫﯿﭻ اﺧﺘﻼف آﻣﺎري ﻣﻌﻨﺎدار دﯾﮕﺮي ﻣﯿﺎن اﯾﻦ دو ﮔﺮوه ﻣﺸﺎﻫﺪه ﻧﺸﺪ. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﺑﺮ اﺳﺎس ﯾﺎﻓﺘﻪ ﻫﺎي اﯾﻦ ﭘﮋوﻫﺶ، ﻣﯿﺎﻧﮕﯿﻦ ﻃﻮل ﻣﺪت ﻋﻤﻞ ﮔـﺮوه آﭘﺎﻧﺪﮐﺘﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ دوﭘﻮرت ﺗﮏ ﺑﺮش ﺑﻪ ﻃﻮر ﻣﻌﻨﺎداري ﮐﻤﺘﺮ ﺑﻮد، ﺑﻪ ﻣﺪﯾﺮﯾﺖ درد ﮐﻤﺘﺮي ﻧﯿﺎز داﺷﺖ؛ ﻫﻢ ﭼﻨﯿﻦ ﻧﺘﯿﺠﻪ آن از ﺟﻨﺒﻪ زﯾﺒﺎﯾﯽ ﻣﺸـﺎﺑﻪ ﺑﻪ آﭘﺎﻧﺪﮐﺘـﻮﻣﯽ ﻻﭘﺎراﺳﮑﻮﭘﯿﮏ ﺑﯿﻦ ﻧﺎﻓﯽ ﺗﮏ ﭘﻮرت ﺑﻮد.

Introduction & Objective: Laparoscopic management of diseases has now been accepted as a golden standard in international societies. However, there are still many studies on the newest methods of minimally invasive surgery in order to achieve the best surgical procedure with the most favorable post-operative outcomes. The purpose of this study was to compare the results of postoperative outcomes of single-port trans-umbilical laparoscopic appendectomy and single-incision two-port laparoscopic appendectomy. Materials & Methods: In this retrospective study, 77 patients participated who underwent single-port trans-umbilical laparoscopic appendectomy and single-incision two-port laparoscopic appendectomy during one year (May 2017-2018). In single-incision two-port laparoscopic appendectomy group, two 5-mm trocars were implanted in a trans-umbilically, and another hole was used for left-hand instruments. Demographic specifications, operation data, and post-operative results of groups were compared using Chi-squared test or, if necessary, Fisher test. The T-test was used to compare the average of the two target groups that were independent of each other. The significance level of the tests was considered to be 0.05. Statistical analyses were performed using the SAS EG 5.1 server, version 9.3. (SAS Institute Inc., Cary, NC, USA) Results: The total average time of single-incision two-port laparoscopic appendectomy surgery was significantly lower than that of single-port trans-umbilical laparoscopic appendectomy (P = 0.003). The average laparoscopic time was significantly lower in the single-incision two-port laparoscopic appendectomy group (P < 0.001). The average number of postoperative analgesic drugs in the single-incision two-port laparoscopic appendectomy group was significantly lower than that of single-port trans-umbilical laparoscopic appendectomy (p = 0.002). The average number of hospitalization post-operative days in the single-incision two-port laparoscopic appendectomy was significantly lower than that of single-port trans-umbilical laparoscopic appendectomy group (P = 0.008). No other statistically significant difference was observed between the two groups. Conclusions: According to the findings of this study, the average number of duration of the single-incision two-port laparoscopic appendectomy was significantly lesser and thus required less pain management; also, in aesthetic point of view, its result was similar to that of single-port trans-umbilical laparoscopic appendectomy.