腹腔镜与开腹阑尾切除术治疗急性阑尾炎的疗效对比分析  

Laparoscopic versus Conventional Open Appendectomy for Appendicitis

作　　者：杜亚琼[1] 花豹 吴巨钢[1] 倪晓春[1] 王守练[1] 姜波健[1] 俞继卫[1] DU Ya-qiong HUA Bao WU Ju-gang NI Xiao-chun WANG Shou-lian JIANG Bo-jian YU Ji-wei(Department of General Surgery, Ninth People＇s Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 201999, China)

机构地区：[1]上海交通大学医学院附属第九人民医院北院普外科,上海201999

出　　处：《中国普外基础与临床杂志》2016年第10期1231-1235,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的比较腹腔镜和开腹阑尾切除术治疗急性阑尾炎的手术效果及其优缺点。方法回顾性分析2013年1月至2014年12月期间在笔者所在医院科室行阑尾切除术的急性阑尾炎患者的资料,纳入研究患者201例,分为腹腔镜组(102例)和开腹组(99例),比较2组患者手术中以及手术后的相关临床指标。结果腹腔镜组和开腹组患者术前基线特征比较差异无统计学意义(P>0.05),具有可比性。腹腔镜组患者的手术时间、术后肠道功能恢复时间、下床活动时间以及住院时间短于开腹组,但住院费用高于开腹组,差异均有统计学意义(P<0.05);同时,2组患者的腹腔感染率、腹腔引流率及30 d内再入院率相近,差异无统计学意义(P>0.05)。多因素回归分析结果显示,阑尾穿孔及腹腔镜手术能够增加腹腔引流率〔OR=2.710,95%置信区间(1.129,6.507),P=0.026〕。结论腹腔镜手术和开腹手术都是治疗急性阑尾炎安全有效的方法。但与开腹阑尾切除术相比,腹腔镜阑尾切除术具有手术时间短、切口感染率低、术后下床时间早、肠道功能恢复快和住院时间短的优势,尽管住院费用更高,仍可作为急性阑尾炎的首选方法。此外,腹腔镜阑尾切除术是影响腹腔引流的独立危险因素。Objective To compare the outcomes of laparoscopic appendectomy （LA） and open appendectomy （OA） for the acute appendicitis patients based on our extensive experiences. Methods The data of all the acute appendi- citis patients who underwent appendectomy from January 2013 to December 2014 in our department were retrospectively reviewed. A total of 201 patients were enrolled and divided into LA group （n=102） and OA group （n=99）. The relevant clinical indexes during and after operation of two groups were compared. Results There were no significant difference in age, gender, and underlying disease between LA and OA patients （P〉0.05）. And the abdominal cavity infection rate, abdominal drainage rate and 30-day readmission rate were also similar （P〉0.05）. But LA group had less operative time, lower infection operative wound rate, less intestinal function recovery time, shorter inhospital days and higher hospital expenses than OA group （P〈0. 05）. In addition, perforated appendix and LA could increase the rate of abdominal drainage [OR=2.710, 95% CI （1.129, 6.507）, P=0.026]. Conclusions Both LA and OA are safe and effective methods for the treatment of acute appendicitis. But LA has several advantages over OA on less operative time and postoperative compli- cations, earlier recovery, and shorter inhospital days. While LA have higher hospital cost than OA, it still should be considered as a prefer way to cure acute appendicitis. LA is a independent risk factor of abdominal drainage.

关 键 词：急性阑尾炎 腹腔镜阑尾切除术 开腹阑尾切除术 术后并发症 

分 类 号：R656.8[医药卫生—外科学]