腹腔镜阑尾切除术腹腔脓肿影响因素分析

Analysis of Influencing Factors of Abdominal Abscess in Laparoscopic Appendectomy

目的探讨腹腔镜阑尾切除术(LA)后发生腹腔脓肿的危险因素。方法选取2018年1月~2020年6月在我院行LA治疗后并发腹腔脓肿的68例急性阑尾炎患者作为腹腔脓肿组,另选取术后未发生腹腔脓肿68例急性阑尾炎患者作为无腹腔脓肿组,比较两组体重指数(BMI)、性别、术前病程、年龄、术中出血量、手术时间、是否放置引流管、实施腹腔冲洗、术后使用抗生素时间等资料,分析LA术后患者发生腹腔脓肿的危险因素。结果腹腔脓肿组年龄≥50岁、腹腔冲洗、手术时间≥50 min、抗生素使用时间≥5 d比例高于无腹腔脓肿组,差异有统计学意义(P<0.05);两组BMI、性别、术前病程、术中出血量、放置引流管比较,差异无统计学意义(P>0.05);Logistic回归分析显示,腹腔冲洗、手术时间≥50 min是LA术后并发腹腔脓肿的独立危险因素。结论LA术后并发腹腔脓肿与腹腔冲洗、手术时间等多种因素密切相关,手术医生需掌握熟练的腹腔镜操作技术,术中避免不必要的腹腔冲洗,以降低腹腔脓肿发生率。

Objective To investigate the risk factors of abdominal abscess after laparoscopic appendectomy(LA).Methods 68 patients with acute appendicitis who had abdominal abscess after LA treatment in our hospital from January 2018 to June 2020 were selected as the abdominal abscess group.In addition,68 patients with acute appendicitis who did not develop abdominal abscess after operation were selected as the non-abdominal abscess group.Compare the two groups'body mass index(BMI),gender,preoperative course of disease,age,intraoperative blood loss,operation time,whether to place a drainage tube,perform abdominal cavity irrigation,and use antibiotics after surgery.To analyze the risk factors of abdominal abscess in patients after LA.Results The proportion of the abdominal abscess group with age≥50 years,abdominal cavity washing,operation time≥50 min,and antibiotic use time≥5 d was higher than that in the abscess group without abdominal abscess,the difference was statistically significant(P<0.05);There was no statistically significant difference in BMI,gender,preoperative course of disease,intraoperative blood loss,and drainage tube placement between the two groups(P>0.05);Logistic regression analysis showed that abdominal cavity washing and operation time≥50 min were independent risk factors for abdominal abscess after LA.Conclusion The complications of abdominal abscess after LA are closely related to various factors such as abdominal irrigation and operation time.The surgeon needs to master skilled laparoscopic operation techniques and avoid unnecessary abdominal irrigation during the operation to reduce the incidence of abdominal abscess.