老年急性阑尾炎患者单孔腹腔镜和腹腔镜与开腹阑尾切除术的对比研究

Comparison of the clinical effects among single-incision laparoscopic appendectomy,laparoscopic appendectomy and open appendectomy in elderly patients with acute appendicitis

目的对比分析单孔腹腔镜阑尾切除术(SILA)、腹腔镜阑尾切除术(LA)和开腹阑尾切除术(OA)治疗老年人急性阑尾炎的临床疗效。方法回顾性研究,连续选取2014年11月至2016年12月行阑尾切除术的老年患者98例,其中31例行SILA(SILA组)、35例行LA(LA组),32例行OA(OA组)。分析3组患者手术时间、术后排气时间、住院时间、疼痛数字评分(NRS)、伤口感染率和术后并发症发生率等方面的差异。结果SILA组和LA组患者术后排气时间分别为(21.5±5.2)h和(22.1±5.4)h、住院时间分别为(4.5±1.3)d和(4.8±1.4)d、NRS为(3.7±0.5)分和(4.1±0.7)分、伤口感染率均为0%,术后并发症发生率分别为9.7%(3/31)和14.3%(5/35),优于OA组患者的(24.8±5.8)h、(9.4±1.5)d、(6.3±0.9)、43.8%(14/32),差异有统计学意义(均P<0.05),LA组和OA组的手术时间分别为(45.4±10.5)min和(48.6±9.5)min,均少于SILA组患者(73.2±12.3)min(P<0.05),SILA组切口NRS为(3.7±0.5)分,低于LA组(4.1±0.7)分和OA组患者(6.3±0.9)分(P<0.05)。结论LA具有创伤小,疼痛少,恢复快,并发症少,切口美观的优点;SILA后疼痛更轻,但手术时间较长,在老年急性阑尾炎手术中值得推广,但仍需进一步改进。

Objective To compare the clinical effects among single-incision laparoscopic appendectomy(SILA),laparoscopic appendectomy(LA)and open appendectomy(OA)in the treatment of elderly patients with acute appendicitis.Methods A total of 98 consecutive elderly patients undergoing appendectomy in our hospital from November 2014 to December 2016 were retrospectively selected.Among them,31 patients underwent SILA,35 underwent LA and 32 underwent OA.The operation time,the first exhaust time after operation,length of hospital stay,Numerical Rating Scale(NRS)pain score,wound infection rate and incidence of postoperative complications were compared between the three groups.Results The postoperative venting time and length of hospital stay were shorter,NRS was less,wound infection rate and incidence of postoperative complications were lower in the SILA and LA groups than in the OA group[(21.5±5.2)h,(22.1±5.4)h vs.(24.8±5.8)h,(4.5±1.3)d,(4.8±1.4)d vs.(9.4±1.5)d,(3.7±0.5),(4.1±0.7)vs.(6.3±0.9),0%,0% vs.12.5%,9.7% or 3/31,14.3% or 5/35 vs.43.8% or 14/32,respectively,(P<0.05),while the operative time was less in the LA and OA groups than in the SILA group(45.4±10.5)min,(48.6±1.4)min vs.(73.2±12.3)min,(P<0.05)].The incision NRS pain score was lower in the SILA group than in the LA and OA groups(3.7±0.5 in SILA vs.4.1±0.7 in LA vs.6.3±0.9 in OA,P<0.05).Conclusions LA has advantages of less trauma,less pain,quicker recovery,fewer complications and beautiful incisions.SILA has less pain than LA,but needs longer operative time.SILA is worthy of promotion in the treatment of acute appendicitis especially in the elderly,but still needs further improvement.