腹腔镜下阑尾切除术与传统术式治疗老年阑尾炎对比研究

Comparative study of laparoscopic appendectomy and traditional surgery in the treatment of the elderly with appendicitis

目的:比较合并基础病老年阑尾炎患者行腹腔镜下阑尾切除术与传统开腹阑尾切除术的临床疗效。方法:回顾性分析我院2016年1月~2020年1月收治的急性阑尾炎行阑尾切除术的60例合并基础基础的老年患者临床资料。根据切除术式的不同分为腹腔镜下阑尾切除术组(腹腔镜组,n=32)和开腹阑尾切除术组(开腹组,n=28),比较两种术式手术相关指标(手术时间、术中出血量、置管引流、切口长度)、术后相关指标(下床活动时间、术后首次排气时间、术后疼痛评分、止痛药使用、胃肠功能恢复时间、术后随机血糖值)、术后主要并发症发生情况以及住院时间、费用。结果:腹腔镜组患者的术中出血量、置管引流、切口长度、下床活动时间、术后首次排气时间、术后疼痛评分、止痛药使用、胃肠功能恢复时间、术后随机血糖值均低于开腹组,而手术时间要长于开腹组,差异均有统计学意义(P<0.05);腹腔镜组患者术后并发生症发生率15.63%(5/32)低于开腹组的42.86%(12/28)(χ^(2)=5.454,P=0.020);腹腔镜组患者的住院时间要短于开腹组(P<0.05),住院综合费用要高于开腹组但没有统计学意义(P>0.05)。结论:对于手术耐受性较差的合并基础疾病老年患者,采用创伤小、恢复快的腹腔镜下阑尾切除术能够缩短住院时间,降低术后痛苦,且并发症少,是一种较为理想的手术方式。

Objective:To compare clinical curative effect of laparoscopic appendectomy and traditional open appendectomy on elderly patients with underlying diseases and appendicitis.Methods:The clinical data of 60 elderly patients with acute appendicitis and underlying diseases who underwent appendectomy and were admitted to the hospital between January 2016 and January 2020 were retrospectively analyzed.According to different surgical methods,they were divided into laparoscopic appendectomy group(laparoscopic group,n=32)and open appendectomy group(open group,n=28).The surgical related indexes(operation time,intraoperative blood loss,catheter drainage,incision length),postoperative related indexes(off-bed activity time,postoperative first exhaust time,postoperative pain score,analgesics usage,recovery time of gastrointestinal function,postoperative random blood glucose value),occurrence of postoperative major complications,hospitalization time and cost were compared between the two groups.Results:The intraoperative blood loss,catheter drainage,incision length,off-bed activity time,postoperative first exhaust time,postoperative pain score,analgesics usage,recovery time of gastrointestinal function and postoperative random blood glucose value in laparoscopic group were lower than those in open group,while operation time was longer than that in open group(P<0.05).The incidence of postoperative complications in laparoscopic group was lower than that in open group[15.63%(5/32)vs 42.86%(12/28)](χ^(2)=5.454,P=0.020).The hospitalization time in laparoscopic group was shorter than that in open group(P<0.05),while comprehensive hospitalization cost was higher than that in open group(P>0.05).Conclusion:For elderly patients with underlying diseases and poor surgical tolerance,the application of laparoscopic appendectomy(little trauma,quick recovery)can shorten hospitalization time,and reduce postoperative pain,with fewer complications.It is a kind of ideal surgical method.