腹腔镜一期手术治疗阑尾周围脓肿临床探讨

Clinical study exploration of a one stage laparoscopic surgery in the treatment of periappendiceal abscess

目的研究腹腔镜一期手术治疗阑尾周围脓肿的临床效果和可行性。方法选择2012年10月~2015年10月我院收治的118例急性阑尾周围脓肿患者,根据术式的不同分为A组(48例)、B组(38例)、C组(32例)。A组行腹腔镜手术,B组行开腹手术,C组采用保守治疗,分析三组的手术时间、住院时间、住院费用、并发症发生率等。结果 A组中,38例进行一期腹腔镜阑尾切除术,10例进行脓肿引流术,无中转开腹。B组中,20例行一期阑尾切除术,18例行脓肿引流术。A组的手术持续时间短于B组,切口长度长于B组,差异有统计学意义(P<0.01)。A组与B组的引流量、术中出血量比较,差异无统计学意义(P>0.05)。A组的体温和白细胞恢复正常时间、术后下床时间、肛门排气时间、引流时间、使用抗生素时间、住院时间短于B组,并发症发生率低于B组,差异有统计学意义(P<0.01)。A组与B组的住院费用比较,差异无统计学意义(P>0.05)。A组的体温和白细胞恢复至正常时间、住院时间短于C组,并发症发生率低于C组,差异有统计学意义(P<0.05)。B组的体温和白细胞恢复正常时间短于C组,并发症发生率高于C组,差异有统计学意义(P<0.05)。B组与C组的住院费用、住院时间比较,差异无统计学意义(P>0.05)。结论腹腔镜一期手术治疗阑尾周围脓肿具有可行性和安全性,优于开腹手术及保守治疗,损伤小、恢复快、切口不易感染,能够明显缩短阑尾周围脓肿的病程。

Objective To study the clinical efficacy and feasibility of a one stage laparoscopic surgery in the treatment of periappendiceal abscess.Methods From October 2012 to October 2015,118 cases of acute periappendiceal abscess in our hospital were selected and divided into group A （48 cases）,group B （38 cases） and group C （32 cases） according to the different methods of operation.Group A was treated with laparoscopic surgery,group B was treated with open surgery,and group C was treated with conservative treatment.The operation time,hospitalization time,hospitalization ex- penses,the incidence rate of complications of the three groups were analyzed.Results In group A,38 patients underwent one stage laparoscopic surgery,and 10 patients underwent abscess drainage without conversion to laparotomy.In group B,20 cases underwent one stage appendectomy,and 18 cases received abscess drainage.The duration of operation in group A was shorter than that in group B,and the length of incision in group A was longer than that in group B,with significant difference （P〈O.O1）.There was no significant difference between group A and group B in the amount of drainage and the amount of bleeding during operation （P〉0.05）.The body temperature and the time of normal recovery of leukocyte,the time of getting out of bed,the time of anal exhaust,the time of drainage,the time of using antibiotics and the length of hospitalization in group A was shorter than that of group B,and the incidence rate of complication in group A was lower than that of group B,with significant difference （P〈0.01）.There was no significant difference between group A and group B in the hospitalization expenses （P〉0.05）.The body temperature and the time of normal recovery of leukocyte,hospitalization time in group A were shorter than that in group C,and the incidence rate of complication in group A was lower than that in group C,with significant difference （P〈0.05）.The body temperature and the time of nor- mal recovery of leukocyte in group B was shorter than that in group C,and the incidence rate of complication in group B was higher than that in group C,with significant difference （P〈0.O5）.There was no significant difference between group B and group C in the hospitalization expenses and the hospitalization time （P〉0.05）.Conclusion One stage la- paroscopic surgery in the treatment of periappendiceal abscess is feasible and safe,which is better than open surgery and conservative treatment,less damage,quick recovery,less infection,and can shorten the course of periappendiceal abscess.