腹腔镜阑尾切除术两种阑尾残端处理方法的前瞻性对比研究

Two Methods for Closing Appendiceal Stump in Laparoscopic Appendectomy: a Prospectively Comparative Study

目的前瞻性对比腹腔镜阑尾切除术(LA)两种阑尾残端处理方法的临床效果,为临床选择LA阑尾残端处理方法提供参考。方法选取2013年1月-2016年8月在复旦大学附属金山医院因急性阑尾炎接受急诊LA的患者200例,采用电脑随机分成对照组和塑料夹组(Hem-o-lok组),各100例。对照组阑尾残端用丝线单纯结扎或结扎+缝扎,不包埋;Hem-o-lok组阑尾残端采用Hem-o-lok夹闭。比较两组手术时间(切皮开始到缝合完毕时间)、住院时间及住院费用,术后并发症(疼痛、肠梗阻、感染)发生情况,再次手术及中转开腹情况。结果 Hem-o-lok组98例顺利完成LA,2例中转开腹,1例因腹腔脓肿二次手术;对照组99例完成LA,1例中转开腹,无二次手术。对照组手术时间长于Hem-o-lok组(P<0.001)。两组患者住院时间、住院费用、术后并发症发生率、再次手术率、中转开腹率比较,差异无统计学意义(P>0.05)。两组均无肠梗阻再入院。结论 2种处理阑尾残端的方法同样安全有效,结扎+缝扎处理阑尾残端对术者腹腔镜操作水平要求较高,操作时间长。Hem-o-lok夹闭阑尾根部节省手术时间,操作简单,可作为首选方案。

Objective To prospectively and comparatively study two methods for closing the appendiceal stump in laparoscopic appendectomy(LA),proving a reference for clinical management of such cases.Methods We enrolled 200 cases of acute appendicitis who underwent emergency LA in Jinshan Hospital of Fudan University from January 2013 to August 2016,and randomly divided them into the control group(n=100)and hem-o-lok group(n=100)by a computer-based method.For patients in the control group,appendiceal stump was ligated or ligated with suture using silk thread,but not embedded during the procedure,while for those in the hem-o-lok group,appendiceal stump was only clamped by hem-o-lok.Then data of both groups were collected and analyzed,including duration of operation(from skin incision to suture completed),duration and cost of hospitalization,perioperative complications(pain,intestinal obstruction,infection),reoperation and conversion to laparotomy.Results In the hem-o-lok group,98 cases had successful LA,2 cases turned to open appendectomy,and 1 case underwent reoperation because of abdominal abscess.In the control group,99 cases had successful LA,1 case turned to open appendectomy,and no reoperation case.The control group had longer duration of operation compared with the hem-o-lok group(P<0.001).There were no significant differences concerning duration and cost of hospitalization,the occurrence of postoperative complications and reoperation and conversion to laparotomy(P>0.05).There was no intestinal obstruction in both groups.Conclusion Both methods for closing appendiceal stump in LA are safe and effective.Ligation or ligation with suture of the appendiceal stump needs highly skilled laparoscopic manipulation and longer duration of operation,but hem-o-lok clamping of the appendiceal stump is simple and needs less duration of operation,so it may be used as the first choice for closing appendiceal stump in LA.