腹腔镜手术治疗肾移植受者术后急性阑尾炎有效性及安全性分析  

Safety and efficacy of laparoscopy for acute appendicitis in kidney transplant recipients

作　　者：山院飞[1] 王翀[1] 王伟强 谭志军[1] Shan Yuanfei;Wang Chong;Wang Weiqiang;Tan Zhijun(Department of General Surgery,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院普通外科,天津300192

出　　处：《中华器官移植杂志》2023年第8期468-472,共5页Chinese Journal of Organ Transplantation

基　　金：天津市第一中心医院科技基金(2020CF24)。

摘　　要：目的探讨腹腔镜阑尾切除术治疗肾移植术后急性阑尾炎的疗效及安全性。方法回顾性分析天津市第一中心医院2016年5月至2022年12月急性阑尾炎受者资料,33例肾移植术后急性阑尾炎受者设为观察组。经倾向性评分匹配,66例自体肾功能正常急性阑尾炎患者作为对照组,比较两组围手术期炎症相关指标(白细胞计数、中细粒细胞百分比、C反应蛋白、降钙素原)及手术相关指标(手术时间、住院时间、术中失血量、住院费用、术后引流量、术后第1次排气时间、手术并发症)。结果术前观察组(33例)和对照组(66例)相比,白细胞计数较低[11.85(9.54~13.99)×10^(9)/L比13.74(12.42~14.66)×10^(9)/L,Z=-3.908,P<0.01],中性粒细胞比率也较低[85.00(73.65~89.60)%比88.20(83.85~90.20)%,Z=-2.522,P=0.012],两组差异均有统计学意义。术前两组C反应蛋白、降钙素原差异均无统计学意义(均P>0.05)。术后3 d两组的炎症指标(白细胞计数、中性粒细胞比率、C反应蛋白、降钙素原)差异无统计学意义(均P>0.05)。观察组手术前后肌酐水平差异无统计学意义(P>0.05)。观察组手术时间较对照组长[86(74~99)min比62(57~68)min,Z=-6.290,P=0.020],术中失血量[25(20~33)ml比15(15~20)ml,Z=-6.104,P<0.01]及术后引流量[75(65~85)ml比35(25~36)ml,Z=-8.103,P<0.01]增多,术后住院时间[7(6~9)d比5(4~5)d,Z=-7.064,P<0.01]及住院总费用[(1.98±0.22)万元比(1.73±0.22)万元,t=5.401,P<0.01]增加。两组术后第1次排气时间差异无统计学意义(P=0.669)。观察组和对照组手术并发症发生率差异无统计学意义(P=0.893)。结论肾移植术后受者腹腔镜阑尾切除术治疗急性阑尾炎与肾功能无异常患者疗效基本一致。Objective To explore the efficacy and safety of laparoscopy for acute appendicitis(AA)in kidney transplant(KT)recipients.Methods From May 2016 to December 2022,retrospective review is conducted for 99 AA patients operated at Tianjin First Central Hospital.They are assigned into two groups of observation(kidney transplant recipients,33 cases)and control(normal renal function patients,66 cases).Laparoscopic perioperative data of white blood cell(WBC),neutrocyte percentage(NEUT%),C-reactive protein(CRP),procalcitonin(PCT),operative duration,intraoperative blood loss,postoperative drainage volume,postoperative hospitalization length,total hospitalization expense and morbidity of postoperative complications are compared.Results After propensity score matching,no statistically significant inter-group difference existed in clinical profiles.WBC and NEUT%pre-operation are lower in observation group than those in control group[11.85(9.54~13.99)×10^(9)/L vs 13.74(12.42~14.66)×10^(9)/L,Z=-3.908,P<0.01;85.00(73.65~89.60)%vs 88.20(83.85~90.20)%,Z=-2.522,P=0.012].No significant inter-group difference existed in preoperative CRP/PCT(all P>0.05).No significant inter-group differences existed in WBC,NEUT,CRP or PCT at Day 3 post-operation(all P>0.05).No significant difference existed in creatinine level in observation group before and after operation(P>0.05).As compared with control group,operative duration was longer[86(74~99)vs 62(57~68)min,Z=-6.290,P=0.020],intraoperative blood loss greater[25(20~33)vs 15(15~20)ml,Z=-6.104,P<0.01],postoperative drainage volume larger[75(65~85)vs 35(25~36)ml,Z=-8.103,P<0.01],postoperative hospitalization time longer[7(6~9)d vs 5(4~5)d,Z=-7.064,P<0.01]and total hospitalization expense higher[(1.98±0.22)vs(1.73±0.22)ten thousand yuan,t=5.401,P<0.01].No significant inter-group differences existed in time of postoperative passage of flatus(P=0.669).No significant inter-group difference existed in morbidity of postoperative complications(P=0.893).Conclusions The efficacy of laparoscopic appendec

关 键 词：肾移植 阑尾炎 腹腔镜 安全 

分 类 号：R699.2[医药卫生—泌尿科学]