腹腔镜阑尾切除术与开腹阑尾切除术的临床对比研究

A clinical comparative study on laparoscopic appendectomy vs open appendectomy

目的探讨腹腔镜阑尾切除术在阑尾炎治疗中的应用和治疗价值。方法回顾性总结吉林大学中日联谊医院2009-2014年间手术治疗1716例阑尾炎患者的临床资料。将1716例分为两组．腹腔镜阑尾切除术组，开腹阑尾切除术组，对比两组患者的手术时间、手术并发症、术后疼痛感及术后恢复情况。采用χ^2检验及t检验进行数据分析。结果术前合并慢性肺疾患以及有腹部手术史的患者所占比例，开腹组高于腹腔镜组（r=3．527，22．804，均P〈0．05）；术后深静脉血栓、肠梗阻、腹腔脓肿、切口感染发生情况，开腹组均高于腹腔镜组（r=4．179，4．71，7．351，8．766，均P〈0．05）；术后24h疼痛感，开腹组高于腹腔镜组（t=-3．163，P=0．004）；两组的手术持续时间，差异无统计学意义（t=1．754，P=0．0922）；术后肠蠕动恢复时间、瘢痕平均长度、平均住院时间开腹组均高于腹腔镜组（t=3．460，-15．335，-3．629，均P〈0．05），平均住院费用，开腹组〈腹腔镜组（t=5．763，P〈0．05）。结论在治疗效果上腹腔镜阑尾切除与开腹阑尾切除手术无明显区别，但在减轻术后疼痛、降低术后并发症和感染、实现快速恢复、缩短住院时间，改进美容效果等方面，腹腔镜阑尾切除优势明显。

Objective To compase laparoscopic vs open appendectomy in the treatment of appendicitis. Methods The clinical data of 1 716 appendicitis patients are studied in the form of retrospective summary, who were hospitalized in Jilin University China-Japan Union Hospital from 2009 to 2014. Patients were divided into laparoscopic appendectomy group and open appendectomy group. Duration of operation, surgical complications and postoperative recovery were evaluated. The chi-test and the student t test were used for statistics. Results More patients in open group with chronic lung disease, or a history of previous abdominal surgery than in the laparoscopic group （χ^2 = 3. 527, 22. 804, P 〈 0. 05 ） ; the postoperative deep vein thrombosis, intestinal obstruction, abdominal abscess and infection of incision in open group were more often seen than in laparoscopic group （χ^2= 4. 179,4. 71,7. 351,8. 766, P 〈 0. 05 ） ; Open group scored higher than laparoscopic group on the index of 24 hours of postoperative pain （ t = - 3. 163, P = 0. 004 ） ; duration of surgery was similar （ t = 1. 754, P = 0. 092 2 ） ; the laparoscopic group was better in recovery time of postoperative intestinal peristalsis, average length of scar and the average hospital stay （t = 3. 460, - 15. 335, - 3. 629, P 〈 0.05 ）. While the average hospitalization cost in open group is less than in the laparoscopic group （ t = 5. 763, P = 0. 001 ）. Conclusions Both laparoscopic appendectomy and open appendectomy were effective for the treatment of appendicitis, while laparoscopic appendectomy is superior to open procedure in reducing postoperative pain, postoperative complications promoting rapid recovery, shortening hospital stay and more cosmetic.