不同术式阑尾切除术后切口感染的对比分析一项大型多中心回顾性研究

Wound infection after emergency appendectomy by open vs laparoscopic approach： a multicenter retrospective large cohort study

目的 探讨腹腔镜阑尾切除手术（laparoscopic appendectomy,LA）后常见并发症切口感染的发生情况.方法 回顾性分析2011-2013年华东地区6家县市级医院所有急性阑尾炎手术患者的临床资料,对LA和开腹阑尾切除术（open appendectomy,OA）后的结果进行对比,并对所有阑尾切除术后导致切口感染的危险因素进行多因素回归分析.结果 9 340例患者中行LA阑尾切除术1 831例（19.6％）,开腹阑尾切除术7 509例（80.4％）;3年间LA手术开展的比例分别为9.2％、15.0％及32.9％.所有阑尾切除患者的术后切口感染并发症发生率为5.1％,其中LA为2.1％,OA为5.8％,两者差异有统计学意义（x2 =41.22,P＜0.01）;3年间LA术后切口感染并发症发生率分别为5.6％、4.4％及3.5％,呈逐年下降趋势（x2=31.59,P＜0.01）.多因素回归分析证实,不同手术方式是导致阑尾切除术后并发切口感染的一项独立影响因素（优势比1.37,95％可信区间1.12 ～1.63,P =0.02）.结论 LA阑尾切除术后切口感染的发生率逐年下降,LA手术是阑尾切除术后并发切口感染的独立保护因素.

Objective Emergency laparoscopic appendectomy （LA） has been rapidly applied at county-level hospitals in China.This study is to analyze wound infection after appendectomy.Methods This retrospective study was conducted among patients with acute appendicitis undergoing either laparoscopic or open appendectomy （OA） at 6 county-level general hospitals in Eastern China from 2011 to 2013,using multivariate Logistic regression model to assess independent risk factors associated with wound infection.Results Among 9 340 patients,1 831 （19.6％） and 7 509 （80.4％） patients underwent LA and OA respectively.The overall postoperative wound infection rate was 5.1％.The proportion of LAs increased yearly from 9.2％ to 15.0％ to 32.9％,while the LA postoperative wound infection rate decreased from 5.6％ to 4.4％ to 3.5％ （P ＜ 0.05）.Compared with OA,LA was associated with lower wound infection rate after appendectomy （2.1％ vs.5.8％,P ＜ 0.01）.By multivariate logistic regression analysis,various procedure was found to be independently associated with postoperative wound infection [odds ratio （95％ confidence interval） OR （95％ CI）,1.37 （1.12-1.63）; P =0.02].Conclusions Laparoscopic appendectomy carries a decreasing postoperative wound infection rate by year basis.Laparoscopic procedure was independently associated with a significantly lower incidence of wound infection after appendectomy.