阑尾切除的术式回顾性分析研究

Selection of operating methods of appendicectomy

目的探讨阑尾切除的术式选择。方法回顾分析2009年10月至2014年10月在高州市中医院行阑尾切除术的350例患者资料,其中行腹腔镜阑尾切除术(腹腔镜组)的患者198例、行传统开腹阑尾切除术(开腹组)患者152例。比较两组的手术时间、术后住院时间、住院费用、术后肛门排气时间、术后疼痛、手术并发症。结果腹腔镜组13例患者中转开腹。腹腔镜组住院费用高于开腹组;慢性阑尾炎、急性单纯性阑尾炎、早期急性化脓性阑尾炎腹腔镜组的患者比开腹组手术时间、术后住院时间短、肛门排气时间早、术后疼痛轻;非早期的急性化脓性阑尾炎及急性坏疽性阑尾炎患者两组的住院时间、肛门排气时间、术后疼痛程度差别无统计学意义;急性坏疽性阑尾炎的腹腔镜组患者比开腹组手术时间长;切口感染率腹腔镜组均比开腹组低。结论腹腔镜阑尾切除术在慢性阑尾炎、急性单纯性阑尾炎、早期急性化脓性阑尾炎中治疗效果确切、优点突出,有良好的临床应用价值;在非早期的急性化脓性阑尾炎及急性坏疽性阑尾炎中与传统开腹手术相比无明显优势,而且增加医疗费用,应用价值不大。

Objective We were to explore the selection of operating methods of appendicectomy. Methods The clinical records of 350 patients who received appendectomy in Gaozhou hospital of TCM from October 2009 to October 2014 were reviewed,among them 198 cases of laparoscopic appendectomy,152 cases were open appendectomy.Comparative analysis of surgical operation time, hospitalize time, postoperative anal exhaust time, hospital costs, postoperative pain and complication were done.Results There were 13 cases fromlaparoscopic appendectomy group convert to open appendectomy group.The hospital costs of the laparoscopic appendectomy group were higher than that in open appendectomy group.Surgical operation time,postoperative anal exhaust time and ambulation time of the chronic appendicitis, acute simple appendicitis and the early phase of acute purulent appendicitis patients in laparoscopic group were shorter than that in open operation group,however, the was postoperative pain was better than the open group.Among the cases with non -early phase of acute purulent appendicitis and acute gangrenous appendicitis, the difference of postoperative anal exhaust time, ambulation time and postoperative pain between the two groups were not statistically significant.In the cases of acute gangrenous appendicitis,the surgical operation time used in laparoscopic group was longer than that in open operation group.The laparoscopic appendectomy group had fewer infection of incision.Conclusions Laparoscopic appendectomy is proved to be effective and advantageousin chronic appendicitis, acute simple appendicitis and the early phase of acute purulent appendicitis and it would be valuable for the treatment of appendicitis in clinical. There is no significant advantage of Laparoscopic appendectomy in non-early phase of acute purulent appendicitis and acute gangrenous appendicitis, in contrastit put up the hospital costs.