腹腔镜阑尾切除术在急性坏疽性阑尾炎的应用分析

Analysis of laparoscopic appendectomy in acute gangrenous appendicitis

目的探讨急性坏疽性阑尾炎行腹腔镜阑尾切除术的安全性及可行性。方法回顾性分析2012年7月~2017年7月在佛山市高明区人民医院普外科住院诊断急性坏疽性阑尾炎并手术治疗的234例患者资料,分为开腹阑尾切除术组(OA组)和腹腔镜阑尾切除术组(LA组)。比较两组的住院时间、住院费用、手术时间、术后首次排气时间、术后首次下地时间、术后8小时视觉模拟疼痛评分及术后并发症。结果 LA组与OA组比较住院时间、手术时间、首次排气时间及患者术后首次下地时间均明显缩短,差异具有统计学意义(P<0.05)。LA组术后疼痛明显低于OA组差异有统计学意义(P<0.05)。术后并发症以切口感染为主,LA组术后总并发症的发生率低于OA组,差异有统计学意义(P<0.05)。结论急性坏疽性阑尾炎行腹腔镜方法是安全、可行的。LA可以降低患者术后疼痛,促进患者尽早下地活动及胃肠功能恢复,降低术后并发症。不过阑尾根部的处理及腹腔冲洗值得重视。

Objective To investigate the acute gangrenous appendicitis line of the safety and feasibility of laparoscopic appendectomy. Methods A retrospective analysis from July 2012 to July 2017 in the People ′ s Hospital of Gaoming District of Foshan City of general hospital diagnosis of 234 cases of patients and surgical treatment of acute gangrenous appendicitis, divided into open appendectomy group（OA group） and laparoscopic appendectomy group（LA group）. The hospitalization time, hospitalization expenses, operation time, the first exhaust time, the first postoperative landing time, visual analogue pain score 8 hours after operation and postoperative complications were compared between the two groups. Results Compared with group OA, the hospitalization time, operation time, the first exhaust time and the first down time of the patients in LA group were significantly shortened（P〈0.05）. The pain after operation in group LA was lower than that in group OA（P〈0.05）. The postoperative complications were mainly infected by incisional wound, and the incidence of postoperative complications in group LA was lower than that in group OA, and the difference was significant（P〈0.05）. Conclusion It is safe and feasible to perform laparoscopic surgery for acute gangrenous appendicitis. LA can reduce postoperative pain, promote the patient＇s activity and gastrointestinal function as soon as possible, and reduce postoperative complications. However, the treatment of the appendiceal stump and copious irrigation of peritoneal cavity should be paid attention.