超重的穿孔或坏疽性阑尾炎患者行腹腔镜手术的近期疗效分析

Short-Term Efficacy of Laparoscopic Appendectomy for Overweight/Obese Patients with Acute Perforated or Gangrenous Appendicitis

目的探讨腹腔镜手术在超重或肥胖(以下统称"超重")的穿孔或坏疽性阑尾炎患者中应用的安全性及近期疗效。方法回顾性分析我院2007年1月至2014年12月期间急性穿孔性或坏疽性阑尾炎接受腹腔镜手术(152例)和开腹手术(60例)患者的临床资料,根据身体质量指数(BMI)将患者分为超重组(BMI≥25 kg/m2,n=69)和正常体重组(BMI<25 kg/m2,n=143),观察指标包括中转率、手术时间、住院时间、再住院率、再手术率、总并发症及各种具体并发症发生率。结果 1超重组和正常体重组行腹腔镜的中转开腹率比较差异无统计学意义〔4.2%(2/48)比6.7%(7/104),χ2=0.06,P>0.05〕。2超重组行腹腔镜的手术时间明显短于超重组行开腹者〔(41.6±11.7)min比(63.1±23.3)min,P<0.01〕,超重组行腹腔镜与正常体重组行腹腔镜比较差异无统计学意义〔(41.6±11.7)min比(39.6±12.7)min,P>0.05〕。3超重组行腹腔镜手术的总并发症率及切口感染率均明显低于超重组行开腹手术者〔总并发症率:16.7%(8/48)比52.4%(11/21),χ2=9.34,P<0.01;切口感染率:4.2%(2/48)比33.3%(7/21),χ2=8.54,P<0.01〕。尽管超重组(腹腔镜和开腹)的总并发症率较正常体重组(腹腔镜和开腹)明显增加〔27.5%(19/69)比14.7%(21/143),χ2=5.02,P<0.01〕,但超重组行腹腔镜与正常体重组行腹腔镜比较差异并无统计学意义〔16.7%(8/48)比12.5%(13/104),χ2=0.45,P>0.05〕。4所有行腹腔镜患者(超重和正常体重)的再手术率明显低于所有行开腹手术患者〔1.3%(2/152)比10.0%(6/60),χ2=6.7,P<0.01〕。5无论超重或正常体重患者行何种手术的腹腔内残余脓肿发生率、肺部感染率及住院时间比较差异均无统计学意义(P>0.05)。结论对于罹患穿孔性或坏疽性阑尾炎的超重患者,腹腔镜手术是较开腹手术更安全、有效的手术方式,与正常体重的穿孔性或坏疽性阑尾炎患者比较,超重状态并不显著增加腹腔镜手术的手术难度及围手术期风险。

Objective To investigate the efficacy and safety of laparoscopic surgery for overweight/obese patients with acute perforated or gangrenous appendicitis.Methods From January 2007 to December 2014,patients with acute perforated or gangrenous appendicitis underwent laparoscopic（152 cases） or open（60 cases） appendectomy were collected,who were retrospectively classified into overweight/obese group（BMI 25 kg/m^2,n=69） or normal weight group（BMI25 kg/m^2,n=143）.Conversion rate,operation time,hospital stay,readmission,reoperation,and postoperative complications such as incision infection,abdominal abscess,and lung infection were analyzed.Results① The rate of conversion to open surgery had no significant difference between the overweight/obese group and the normal weight group[4.2%（2/48） versus 6.7%（7/104）,χ^2=0.06,P0.05）.② The operation time of laparoscopic surgery in the overweight/obese group was significantly shorter than that of the open surgery in the overweight/obese group[（41.6±11.7） min versus（63.1±23.3） min,P0.01）,which had no significant difference between the laparoscopic surgery in the overweight/obese group and laparoscopic surgery in the normal weight group[（41.6±11.7） min versus（39.6±12.7）min,P〉0.05）.③ The total complications rate and incision infection rate of the laparoscopic surgery in the overweight/obese group were significantly lower than those of the open surgery in the overweight/obese group[total complications rate：16.7%（8/48） versus 52.4%（11/21）,χ~2=9.34,P0.01;incision infection rate：4.2%（2/48） versus 33.3%（7/21）,χ~2=8.54,P〈0.01）.Although the total complications rate of all the patients in the overweight/obese group was increased as compared with all the patients in the normal weight group[27.5%（19/69） versus 14.7%（21/143）,χ~2=5.02,P〈0.01）,but which had no significant difference between the laparoscopic surgery in the overweight/obese group and laparoscopic surgery in the normal weight group[16.7%（8/48） versus 12.5%（13/104）,χ~2=0.45,P〉0.05）.④ The reoperation rate of all the patients performed laparoscopic surgery was significantly lower than that of all the patients performed open operation[1.3%（2/152） versus 10.0%（6/60）,χ~2=6.7,P〈0.0l）.⑤ The abdominal abscess rate,lung infection rate,and hospital stay after discharge had no significant differences among all the patients（P〉0.05）.Conclusion Laparoscopic appendectomy could be considered a safe technique for overweight/obese patients with acute perforated or gangrenous appendicitis,which could not increase the difficulty of laparoscopic surgery and the perioperative risk.