腹腔镜手术治疗坏疽及穿孔性阑尾炎的探讨

Investigate The Laparoscopic Operation for Treatment Gangrenous and Perforated Appendicitis

目的探讨腹腔镜手术治疗急性坏疽性及穿孔性阑尾炎的疗效和价值。方法回顾分析笔者所在医院普外科2011年2月至2014年2月期间收治的243例急性坏疽性阑尾炎及急性穿孔性阑尾炎患者的临床资料,其中行腹腔镜阑尾切除术(laparoscopic appendectomy,LA)118例(LA组),行开腹阑尾切除术(open appendectomy,OA)125例(OA组),比较2组的手术时间、住院时间、住院费用、术后切口出血、胃肠功能恢复时间以及切口感染、盆腔脓肿和术后肠粘连的发生情况。结果 LA组与OA组的手术时间以及术后切口出血和盆腔脓肿发生率方面的差异均无统计学意义(P>0.05);与OA组比较,LA组术后胃肠功能恢复时间明显缩短(P<0.01),术后进食时间早(P<0.01),住院时间也明显缩短(P<0.01),术后切口感染及肠粘连发生率显著降低(P<0.01),但住院费用明显增加(P<0.05)。结论腹腔镜手术治疗坏疽性及穿孔性阑尾炎具有疼痛轻、恢复快、住院时间短、并发症少等明显优势,住院费用增高是其仅有的不足。

Objective To explore the curative effect and value of laparoscopic operation in the treatment of acute gangrenous and perforated appendicitis. Methods The clinical data of 243 patients with acute gangrenous and perforated appendicitis from February 2011 to February 2014 in our hospital were retrospectively analyzed. Laparoscopic appendectomy was performed in 118 cases （LA group）, and open appendectomy was performed in 125 cases （OA group）. The operative time, hospital stay, hospital costs, incision bleeding, gastrointestinal function recovery, wound infection, pelvic abscess, and postoperative adhesions of two groups were compared. Results There was no significant difference in the operative time, incision bleeding, and the incidence of pelvic abscess after operation between the LA group and OA group （P〉0.05）. Compared with the OA group, the recovery time of gastrointestinal function was significantly shortened （P〈0.01）, eating time was earlier （P〈0.01）, hospitalization time also shortened significantly （P〈0.01）, and the incidence of postoperative wound infection and intestinal adhesion were significantly decreased （P〈0.01） after operation in LA group. But the cost of hospitalization in LA group increased significantly （P〈0.05）. Conclusions The laparoscopic operation in the treatment of gangrenous and perforated appendicitis are light of pain., recover quickly, shorter of hospital stay, and fewer complications. The increase of hospitalization expenses is the only deficiency.