腹腔镜在慢性阑尾炎诊治中的应用价值(附296例报告)

Laparoscopic versus open appendectomy in chronic appendicitis

目的:比较腹腔镜手术与开腹手术在慢性阑尾炎治疗中的应用价值。方法:回顾分析2000年1月至2008年12月我院施行296例慢性阑尾炎手术的临床资料,164例行开腹手术,132例行腹腔镜手术,对比两组手术时间、术中出血、住院时间、术中发现和处理情况,并随访患者术后慢性腹痛的改善情况。结果:手术时间开腹组(52.76±21.82)m in,腹腔镜组(49.78±18.01)m in,t=0.88,P>0.05;术中出血开腹组(16.60±8.28)m l,腹腔镜组(9.68±4.22)m l,t=3.48,P<0.05;住院时间开腹组(7.84±3.27)d,腹腔镜组(6.80±2.98)d,t=2.98,P<0.05。腹腔镜组30例(22.7%)术中发现不同程度的腹腔粘连,阑尾与周围粘连10例,回盲部与前侧腹壁粘连8例,大网膜与腹壁及肠管粘连6例,升结肠与周围及腹腔内其他粘连6例,均在术中给予松解;开腹组18例(11.0%)术中发现阑尾与周围粘连,松解粘连行阑尾切除术,两组比较χ2=8.06,P<0.05;成功随访122例开腹手术者术后26例(21.3%)仍有慢性腹痛,98例腹腔镜手术者术后10例(10.2%)仍有慢性腹痛,两组比较χ2=6.68,P<0.05。结论:腹腔镜对慢性阑尾炎的诊治有一定的优势。

Objective：To compare the advantages and disadvantages of laparoscopic versus open appendectomy in chronic appendicitis.Methods：Two hundred and twenty-four patients were analyzed following either laparoscopic（132 cases） or open（164 cases） appendectomy.Prospective non-randomized study was done on the operative time,operative blood loss,hospitalization time,the discovery in operation and how to deal with this discovery,and postoperative improvement of abdominal pain in these chronic appendicitis cases was followed up.Results：The operative time was（52.76±21.82）min in open group and（49.78±18.01）min in laparoscopic group,t=0.88,P0.05;The operative blood loss was（16.60±8.28）ml in open group and（9.68±4.22）ml in laparoscopic group,t=3.48,P0.05;The hospitalization time was（7.84±3.27）d in open group and（6.80±2.98）d in laparoscopic group,t=2.98,P0.05.30 cases（22.7%） had abdominal adhesion in 132 laparoscopic cases,10 cases had adhesion around appendix,8 cases had adhesion between ileocecum and anterior or lateral abdominal wall,6 cases with adhesion between great omentum and abdominal wall or intestines,6 cases with adhesion around ascending colon and others.All adhesion had been dissected.18 cases（11.0%） adhesion around appendix were found in open group and dissected,χ2=8.06,P0.05;In follow-up research,26 cases still had chronic abdominal pain in 122 case in open group,and 10 cases of 98 had chronic abdominal pain in laparoscopic group,χ2=6.68,P0.05.Conclusions：The laparoscopic appendectomy has more advantages than laparotomy.