腹腔镜治疗老年急性阑尾炎疗效对比分析

Clinical efficacy of laparoscopy in the treatment of acute appendicitis in the elderly

目的比较腹腔镜与开腹治疗老年(>60岁)以及中青年(18~60岁)急性阑尾炎效果,为腹腔镜治疗老年急性阑尾炎提供临床依据。方法选择2015年1月至2017年1月昆明医科大学附属第二医院收治的老年急性阑尾炎患者160例,其中经腹腔镜治疗80例(老年腹腔镜组),经开腹治疗80例(老年开腹组),另选择同期腹腔镜治疗的中青年急性阑尾炎患者80例为对照(中青年腹腔镜组),比较三组患者的治疗临床疗效。结果 (1)三组间的出院情况差异有统计学意义(χ~2=68.913,P<0.001,α=0.05标准),其中老年腹腔镜组优于老年开腹组(Z=5.868,P<0.001),中青年腹腔镜组优于老年腹腔镜组(Z=6.259,P<0.001)。(2)三组术后并发症发生率差异有统计学意义(χ~2=10.800,P=0.005),以老年开腹组最高[36.2%(29/80)],中青年腹腔镜组最低[13.8%(11/80)]。(3)三组间住院时间、抗生素使用时间、白细胞水平差异有统计学意义(P<0.05),老年腹腔镜组和中青年腹腔镜组的术后排气时间显著短于老年开腹组,差异均有统计学意义(P<0.05),老年患者术后恢复较慢。结论与开腹比较,腹腔镜治疗老年急性阑尾炎具有恢复快、住院时间少、并发症少的优点,但比中青年患者术后排气时间易延迟,并发症高。老年急性阑尾炎患者优先推荐腹腔镜治疗,同时注意促进术后排气、减少并发症。

Objective To compare the effect of laparoscopy and laparotomy in the treatment of elderly patients（over 60 years） and young patients（18-60 years） with acute appendicitis, and to provide clinical basis for laparoscopic treatment of acute appendicitis in the elderly. Methods One hundred and sixty elderly patients with acute appendicitis in the Second Affiliated Hospital of Kunming Medical University from January 2015 to January 2017 were selected. Among them, 80 cases（elderly laparoscopic group） were treated by laparoscopy, 80 cases were treated by laparotomy（elderly laparotomy group）, and 80 cases of young and middle-aged patients with acute appendicitis in the same period were selected as the control group. The clinical efficacy of three groups was compared. Results（1） There was statistically significant difference in discharge between the three groups（χ^2=68.913, P〈0.001）. The elderly laparoscopic group was better than the elderly laparotomy group（Z=5.868, P〈0.001）, and the control group was better than the elderly laparoscopic group（Z=6.259, P〈0.001）.（2） The difference of postoperative complications among the three groups was statistically significant（χ^2=10.800, P=0.005）, with the highest [36.2%（29/80） ] in the elderly laparotomy group, and the lowest [13.8%（11/80）] in the control group.（3） The differences were statistically significant in hospitalization time, antibiotic use time, white blood cell level among the threegroups（P〈0.05）. Compared to the elderly laparotomy group, postoperative exhaust time was significantly shorter in the other groups, the differences were statistically significant（P〈0.05）. The elderly patients had slow recovery after operation. Conclusions Compared with laparotomy, laparoscopic treatment has many advantages, such as quick recovery, less hospitalization time and fewer complications for elderly acute appendicitis, but shows delayed exhaustion and has higher complications than young and middle-aged patients. Laparoscopic treatment is recommended for elderly patients with acute appendicitis, while attention should be paid to promoting postoperative exhaustion and reducing complications.