内镜直视下阑尾炎治疗术对急性阑尾炎患者的疗效与安全性  

Efficacy and safety of endoscopic direct-vision appendicitis therapy in patients with acute appendicitis

作　　者：李明月 梁燕[1] 冯亚东[1] 刘娟[1] 朱铟楠 施瑞华[1] Li Mingyue;Liang Yan;Feng Yadong;Liu Juan;Zhu Yinnan;Shi Ruihua(Department of Gastroenterology,Zhongda Hospital of Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院消化内科,南京210009

出　　处：《中华医学杂志》2025年第11期814-819,共6页National Medical Journal of China

基　　金：国家自然科学基金(82300638);东南大学附属中大医院科研人才培养计划(CZXM-GSP-RC15);东南大学附属中大医院江苏省高水平医院结对帮扶建设项目(zdyyxy13)。

摘　　要：目的分析内镜直视下阑尾炎治疗术(EDAT)治疗急性阑尾炎患者的疗效与安全性。方法回顾性分析2023年5月至2024年7月于东南大学附属中大医院行手术治疗的急性阑尾炎患者的临床资料,根据手术方式分为EDAT组(41例)与腹腔镜阑尾切除术(LA)组(630例)。将两组患者的一般情况、Alvarado评分与基础疾病等进行1∶2的倾向性评分匹配(PSM)后,比较两组患者围手术期与预后的相关指标。随访截止时间为2024年10月30日。结果PSM后,共纳入123例患者,EDAT组41例,男21例,女20例,年龄[M(Q1,Q3)]为55(37,61)岁;LA组82例,男41例,女41例,年龄50(35,60)岁。共随访366(221,492)d。EDAT组手术时间[(38.7±22.3)比(54.8±16.2)min]、术后肠道功能恢复时间[(2.5±1.3)比(21.8±5.0)h]、抗生素使用时间[2(2,2)比3(3,4)d]、住院天数[2(1,2)比3(2,4)d]均短于LA组;术后6 h的疼痛视觉模拟(VAS)评分[(3.2±1.3)比(5.5±1.2)分]低于LA组;术中出血量>20 ml的患者比例[0比61%(50/82)]、使用止痛药的患者比例[7.3%(3/41)比69.5%(57/82)]均低于LA组(均P<0.001)。EDAT组术后复发率高于LA组[4.9%(2/41)比0,P=0.035]。结论EDAT治疗急性阑尾炎患者是有效和安全的,但患者存在复发风险。Objective:To analyse the efficacy and safety of endoscopic direct-vision appendicitis therapy(EDAT)in patients with acute appendicitis.Methods:The clinical data of patients diagnosed with acute appendicitis and underwent surgical treatment from May 2023 to July 2024 at Zhongda Hospital of Southeast University were analysed retrospectively.The patients were divided into EDAT group(41 cases)and laparoscopic appendectomy(LA)group(630 cases)according to the surgical methods.After 1∶2 propensity score matching(PSM)based on general baseline information,Alvarado score and underlying diseases,the perioperative period and prognosis indicators were compared between the 2 groups.The deadline for follow-up was October 30,2024.Results:A total of 123 patients were included after PSM,41 patients in EDAT group,including 21 males and 20 females,aged[M(Q1,Q3)]55(37,61)years;and 82 patients in LA group,including 41 males and 41 females,aged 50(35,60)years.A total of 366(221,492)days were followed up.The operative time[(38.7±22.3)vs(54.8±16.2)min],postoperative intestinal function recovery time[(2.5±1.3)vs(21.8±5.0)h],duration of antibiotic use[2(2,2)vs 3(3,4)d]and hospitalisation days[2(1,2)vs 3(2,4)d]in EDAT group were shorter than those in LA group;postoperative visual analogue scale(VAS)score at 6 hours[(3.2±1.3)vs(5.5±1.2)scores]was lower than that in LA group;the proportion of patients with intraoperative bleeding>20 ml[0 vs 61%(50/82)]and proportion of painkiller use[7.3%(3/41)vs 69.5%(57/82)]were lower than those of LA group(all P<0.001).The rate of postoperative recurrence in EDAT group was higher than that in LA group[4.9%(2/41)vs 0,P=0.035].Conclusion:EDAT is effective and safe in treating patients with acute appendicitis,but patients are at risk of recurrence.

关 键 词：阑尾炎 胆胰管成像系统 内镜直视下阑尾炎治疗术 疗效 安全性 

分 类 号：R65[医药卫生—外科学]