腹腔镜阑尾切除术临床价值再探讨

Further Exploring and Discussing Clinical Value of Laparoscopic Appendectomy

目的再次探讨腹腔镜阑尾切除术的手术价值。方法收集川北医学院附属医院普通外科2009年4月至2010年12月期间收治的已行阑尾切除术的阑尾炎患者共200例的临床资料,比较行腹腔镜阑尾切除术(腹腔镜组)和开腹阑尾切除术(开腹组)患者的手术时间、术后住院时间、住院费用、术后肛门排气时间、术后疼痛得分、手术并发症等。结果腹腔镜组8例患者中转开腹。腹腔镜组住院费用高于开腹组(P<0.05);慢性阑尾炎、急性单纯性阑尾炎、发病36 h内的急性化脓性阑尾炎在腹腔镜组较开腹组手术时间短、术后住院时间短、肛门排气时间较早、术后疼痛轻(P<0.05);超过36 h的急性化脓性阑尾炎及急性坏疽性阑尾炎2组在术后住院时间、肛门排气时间、术后疼痛方面差异均无统计学意义(P>0.05);急性坏疽性阑尾炎在腹腔镜组手术时间较开腹组长(P<0.05),但腹腔镜组切口感染率较开腹组低(P<0.05)。结论慢性阑尾炎、急性单纯性阑尾炎、发病36 h内的急性化脓性阑尾炎经腹腔镜阑尾切除术治疗效果确切,优点突出,应用价值明确;而对于发病超过36 h的急性化脓性阑尾炎及急性坏疽性阑尾炎腹腔镜阑尾切除术手术操作困难,中转率高,术后恢复较开腹手术没有明显优势,并且增加了医疗费用,应用价值不大。

Objective To further explore and discuss the value of laparoscopic appendectomy.Methods The clinical data of 200 patients underwent appendectomy in this hospital from April 2009 to December 2010 were collected.The operation time,postoperative hospital stay,cost of hospitalization,postoperative anal exhaust time,postoperative pain score,and surgical complications were compared between laparoscopic appendectomy and open appendectomy.Results There were 8 cases conversion to the open approach in this series.The cost of laparoscopic appendectomy was higher than that of open appendectomy（P0.05）;the cases of chronic appendicitis,acute simple appendicitis,acute suppurative appendicitis within 36 h of onset treated by laparoscopic appendectomy had shorter operation time,shorter postoperative hospital stay,earlier postoperative anal exhaust time,and slighter postoperative pain than those treated by open appendectomy（P0.05）;the differences in postoperative hospital stay,postoperative anal exhaust time,postoperative pain of acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis treated by two types of surgery had no statistical significances（P0.05）;the operation time of acute gangrenous appendicitis operated by laparoscopic surgery was longer than that by open appendectomy（P0.05）;incision infection rate of laparoscopic appendectomy was lower than that of open appendectomy（P0.05）.Conclusions For chronic appendicitis,acute simple appendicitis,and acute suppurative appendicitis within 36 h of onset,the outcome and advantages of laparoscopic appendectomy are outstanding,the value of application is clear;and for acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis,laparoscopic appendectomy is difficult and with high rate of conversion,no obvious advantages in recovery after surgery but an increase of medical costs,and the application value is not great.