化脓性阑尾炎抗生素治疗后不同时机腹腔镜阑尾切除术的疗效及预后研究

Efficacy and prognosis of laparoscopic appendectomy at different timings after antibiotic treatment for suppurative appendicitis

目的比较化脓性阑尾炎患者抗生素治疗后不同时机行腹腔镜阑尾切除术患者的疗效及预后。方法回顾性分析2019年7月至2020年6月广东医科大学第二临床医学院收治的63例化脓性阑尾炎患者的诊疗情况,根据抗生素治疗开始至手术实施时间进行分组,其中≤72 h的30例患者纳入观察组,>72 h的33例患者纳入对照组。两组患者均在入院后接受抗生素治疗,然后行腹腔镜切除术。比较两组患者术中术后相关临床指标、中性粒细胞比例、白细胞计数、中转开腹率及并发症率。结果观察组和对照组患者的手术时间、术中出血量、术后抗生素治疗时间、引流管留置时间、胃肠功能恢复时间比较差异均无统计学意义(P>0.05);观察组患者的住院时间及医疗费用分别为(5.52±1.14) d、(1.06±0.23)万元,明显短(少)于对照组的(7.76±1.79) d、(1.28±0.30)万元,差异均有统计学意义(P<0.05);观察组患者术前中性粒细胞比例和白细胞计数分别为(80.41±9.57)%、(10.62±2.97)×10^(9)/L,明显高于对照组的(69.36±8.23)%、(18.06±2.24)×10^(9)/L,差异均有统计学意义(P<0.05);观察组患者术后第2 d的中性粒细胞比例和白细胞计数分别为(6.09±1.85)%、(6.69±1.35)×10^(9)/L,分别与对照组的(5.92±1.81)%、(6.52±1.29)×10^(9)/L比较差异均无统计学意义(P>0.05);观察组患者的中转开腹率、并发症分别为3.33%、6.67%,分别与对照组患者的6.06%、12.12%比较差异均无统计学意义(P>0.05)。结论化脓性阑尾炎经抗生素治疗后在不同时机行腹腔镜阑尾切除术均可获得良好的疗效和预后,但72h后手术会导致住院时间延长,医疗成本增加,建议在确保手术条件的情况下尽早手术。

Objective To compare the efficacy and prognosis of patients with suppurative appendicitis who underwent laparoscopic appendectomy at different times after antibiotic treatment. Methods The clinical data of 63 patients with suppurative appendicitis admitted to the Second Clinical College of Guangdong Medical University from July2019 to June 2020 were retrospectively analyzed. According to the time from the beginning of antibiotic treatment to the implementation of operation, 30 patients(≤ 72 h) were divided into observation group, and 33 patients(> 72 h) were divided into control group. Both groups were treated with antibiotics after admission, and then underwent laparoscopic resection. The intraoperative and postoperative clinical indexes, neutrophil ratio, white blood cell count, abdominal opening rate, and complication rate were compared between the two groups. Results There was no significant difference in the operation time, intraoperative blood loss, postoperative antibiotic treatment time, drainage tube indwelling time, and gastrointestinal function recovery time between the observation group and the control group(P>0.05). The hospitalization time and medical expenses of the patients in the observation group were(5.52 ± 1.14) d,(1.06 ± 23) × 10^(4) yuan,which were significantly shorter than or less than(7.76 ± 1.79) d,(1.28 ±3.0)×10^(4) yuan of the control group(P<0.05).The proportion of neutrophils and white blood cell count before operation in the observation group were(80.41±9.57)%,(10.62±2.97)×10^(9)/L, which were significantly higher than(6.69±8.23)%,(18.06±2.24)×10^(9)/L of the control group(P<0.05). There were no significant differences in neutrophil ratio and white blood cell counts on the 2 ndday after operation between the observation group [(6.09±1.85)%,(6.69±1.35)×10^(9)/L] and the control group [(5.92±1.81)%,(6.52±1.29)×10^(9)/L], P>0.05. There were no significant differences in abdominal opening rate and complication rate between the observation group(3.33%, 6.67%) and the control group(6.06%, 12.12%), P>0.05. Conclusion Laparoscopic appendicitis can achieve good efficacy and prognosis at different timeings after antibiotic treatment. However, surgery after 72 h will result in prolonged hospitalization and increased medical costs. It is recommended to operate as soon as possible while ensuring surgical conditions.