腹腔镜阑尾切除术和开腹阑尾切除术的对比研究

A comparative study between laparoscopic appendectomy and open appendectomy for appendicitis

目的总结腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的经验,对比分析腹腔镜阑尾切除术与开腹阑尾切除术(open appendectomy,OA)治疗阑尾炎的疗效和安全性。方法回顾性分析2011年1月至2014年12月在宁夏医科大学总医院接受手术治疗的803例阑尾炎患者的病例资料,分为LA组和OA组,对比分析两组的手术时间、术中出血量、胃肠道功能恢复时间、镇痛药物使用率、住院时间、住院费用等情况,以及切口脂肪液化感染、腹腔脓肿等并发症发生情况。结果本研究LA组367例,中转开腹3例,OA组436例,两组手术时间差异无统计学意义(P=0.72),两组的术中出血量、胃肠功能恢复时间、镇痛药使用率及平均住院时间,LA组明显低于OA组,差异有统计学意义(均P<0.05),LA组的并发症发生率低于OA组(P<0.05),但住院费用高于OA组(P<0.05)。结论 LA较OA具有术后恢复快、住院时间短及并发症发生率低等优点,安全可行,值得推广。

Objective To summarize the clinical experience of laparoscopic appendectomy （LA）, to compare the efficacy and safety between laparoscopic appendectomy and open appendectomy （OA） in the treatment of appendicitis. Methods A total of 803 appendicitis cases in the General Hospital of NingXia Medical University from January 2011 to December 2014 received appendectomy. All cases were divided into two groups, LA group and OA group. The operation time, intraoperative blood loss, gastrointestinal function recovery time, analgesic drug administration, hospital stay and hospitalization expenses as well as postoperative complications such as incision fat liquefaction or infection and abdominal abscess were compared between the two groups. Results There were 367cases in the LA group with 3 cases converted to open surgery, and 436 cases in the OA group. There was no significant difference in operation time between the two groups （P=0.72）. As for intraoperative blood loss, gastrointestinal function recovery time, analgesic drug administration, hospital stay, LA was significantly better than OA （all P〈0.05）.The incidence of postoperative complications was significantly lower, whereas the hospitalization expenses was significantly higher in the LA group than those in the OA group（P〈0.05）. Conclusions Compared with OA, LA has more advantages including shorter recovery time and hospital stay, and lower complication incidence. LA should be recommended as a feasible, effective and safe procedure for appendicitis.