腹腔镜治疗复杂性和非复杂性阑尾炎的疗效分析

Comparative study of laparoscopic appendectomy for complicated and uncomplicated acute appendicitis

目的:比较腹腔镜阑尾切除术在复杂性阑尾炎(Complicated acute appendicitis,CAA)和非复杂性阑尾炎(Uncomplicated acute appendici-tis,UCAA)中的疗效。方法:收集本院2011年1月至2013年2月腹腔镜手术治疗急性阑尾炎患者术前、术中和术后的临床资料,比较CAA组和UCAA组发病时间、弥漫性腹膜炎发生率、血白细胞计数、中性粒细胞比例、腹腔脓液量、腹腔冲洗率、腹腔引流率、手术时间、下床活动时间、肛门通气时间、住院时间、住院费用以及术后并发症的发生率。结果:共有149例患者行腹腔镜阑尾切除术,其中133例病例符合纳入标准。CAA组有48例,UCAA组有85例,无手术死亡发生。术前,CAA组患者在发病时间、弥漫性腹膜炎发生率、血白细胞计数、中性粒细胞比例方面均明显高于UCAA组患者(均P<0.05)。术中,CAA组患者腹腔内脓液量、腹腔冲洗率、腹腔引流率和手术时间均显著高于UCAA组患者(均P<0.05)。CAA组有4例中转开腹手术,UCAA组有2例中转开腹手术,两组手术中转率无统计学差异(8.3%vs 2.4%,P>0.05)。术后,两组下床活动时间、肛门通气时间、Trocar孔感染率、腹腔脓肿发生率、肠梗阻发生率均无统计学差异(均P>0.05)。两组的住院时间和住院费用亦无统计学差异(均P>0.05)。结论:虽然复杂性阑尾炎比非复杂性阑尾炎的炎症重,但腹腔镜治疗复杂性阑尾炎的疗效与非复杂性阑尾炎相当。因此,腹腔镜技术应用于复杂性阑尾炎的治疗可能是一种可行、安全和有效的方法。

AIM. To investigate the effect of laparoscopic appendectomy in both complicated and uncomplicated cases of acute appendicitis. METttODS： A retrospective, observational study design was used to analyze several out-comes using the data of all laparoscopic appen- dectomy procedures from January 2011 to Febru-ary 2013 in patients with complicated or uncom-plicated appendicitis. Data on several surgical outcome measures were collected. RESULTS： A total of 149 laparoscopic appendectomy proce-dures performed. 133 patients with complicated or uncomplicated acute appendicitis were includ-ed in the study. There was no mortality in both CAA group with 48 cases and UCAA group with 85 cases. Preoperatively, in patients with CAA, duration of symptoms, incidence rate of diffuse peritonitis, blood leukocyte count, neutrophil percentage were significantly higher than in pa- tients with UCAA （all P 〈 0.05）. Intraopera-tively, in patients with CAA, quantity of pus, peritoneal irrigation rate, peritoneal drainage rate and operation time were significantly higher than in patients with UCAA （all P （0.05）. Conversion to open surgery was necessary in 4 patients in CAA group and in 2 patients in UCAA group. Conversion rate had no signifi-cant difference between two groups （8. 3% for CAA vs 2.4M for UCAA, P〉0.05）. Postoper-atively, two groups of ambulation time, restora-tion of anal exhaust, incidence rate of Trocar hole infection, incidence rate of intra-abdominal abscess, incidence rate of bowel obstruction had no significant difference （P〉0.05）. In the two groups, the difference between the length of hospital stay and hospital costs also had no sta-tistical significance （P 〉 0.05）. CONCLUSION： Laparoscopic appendectomy for complicated a-cute appendicitis is comparable to uncomplicated acute appendicitis in terms of several surgical outcomes, although the inflammatory response in patients with complicated acute appendicitis is more serious than uncomlicated acute appendici- tis. Therefore, laparoscopic technique may be a feasible, safe, and efficacious method in the therapy of complicated acute appendicitis.