胆道镜应用于阑尾切除术的可行性研究

Clinical Application of Choledochoscope for Appendectomy

目的探讨将胆道镜应用于阑尾切除术的可行性。方法选取我院2009年3月—2010年3月应用胆道镜行阑尾切除术的30例阑尾炎患者(胆道镜手术组)、应用腹腔镜行阑尾切除术的35例阑尾炎患者(腹腔镜手术组)及2008年6月—2009年6月在我院行传统开腹阑尾切除术的58例阑尾炎患者(传统手术组)。比较3组患者的手术时间、术中出血量、术后排气时间、术后并发症发生率、住院时间及住院总费用。结果胆道镜手术组患者术后全部治愈,手术时间为(27.6±8.0)min,术中出血量为(9.7±3.8)ml,术后排气时间为(27.9±4.5)h,住院时间为(4.1±1.0)d,住院总费用为(3 000±309)元;1例(3.3%)发生切口感染,换药治疗约15 d痊愈;5例放置引流管,术后48 h拔出引流管。该组与腹腔镜手术组在手术时间、术后排气时间、住院时间、术中出血量及术后并发症发生率方面差异无统计学意义(P>0.05);但两组上述指标与传统手术组比较,差异有统计学意义(P<0.05)。在住院总费用方面(主要是手术费用),胆道镜手术组较腹腔镜手术组显著降低,差异有统计学意义(P<0.05)。结论将胆道镜应用于阑尾切除术,其效果与腹腔镜手术相当,既达到了微创的目的,又能明显降低医疗费用,是一种安全的术式,且容易在基层医院开展。

Objective To explore the clinical feasibility of the application of choledochoscope for appendectomy. Methods In this retrospective study,we enrolled 30 patients who underwent choledochoscope-assisted appendectomy from March 2009 to March.2010（choledochoscope group）,35 patients who under who underwent laparoscope-assisted appendectomy in the same period（laparoscope group）,and 58 patients who received conventional open open appendectomy from June 2008 to June 2009（conventional group）.The surgery duration,intraoperative blood loss,post-operative flatus time,incidence of post-operative complications,hospital stay and total hospitalization cost were compared among three groups. Results All patients were cured in the choledochoscope group,with surgical duration of（27.6±8.0）min,intraoperative blood loss of（9.7±3.8）ml,post-operative flatus time of（27.9±4.5）h,hospital stay of（4.1±1.0）d,and total hospitalization cost of（3 000±309） yuan.One patient（3.3%） experienced infection at the incision,which was cured 15 days later after changing the drugs.Catheters were placed in 5 paitents,and were withdrawn 48 h after surgery.The choledochoscope group had no significant differences from laparoscope group in terms of surgery duration,hospital stay,intra-operative blood loss,and post-operative incidence of complications（all P0.05）,but were significantly different from conventional group（all P0.05）.The total hospitalization cost,mainly those for surgery,was significantly lower in choledochoscope group than in laparoscope group（P0.05）. Conclusion Choledochoscope has similar effectiveness with laparoscope in appendectomy.It is micro-invasive,cheap,and safe,and therefore is feasible for grassroots hospitals.