腹腔镜下荷包包埋与可吸收夹夹闭处理阑尾残端的临床对照研究

Comparison of purse-string suture and absorbable clip clamping in closing appendiceal stump under laparoscope

选取我院因急性阑尾炎而接受腹腔镜下阑尾切除术的患者525例,根据术中阑尾残端处理方式分为包埋组(腹腔镜下阑尾根部丝线结扎,荷包缝合包埋阑尾残端)及非包埋组(阑尾根部给予可吸收夹夹闭2次)。比较2组患者手术治疗情况及手术时间、住院时间、住院费用、术后1个月并发症发生率。结果2组患者均顺利完成腹腔镜下阑尾切除术,均无严重术后并发症。包埋组手术时间明显长于非包埋组(t=8.313,P=0.001),住院费用明显低于非包埋组(t=2.591,P=0.013);2组患者住院时间、术后并发症发生率比较,无明显统计学差异(P>0.05)。结论腹腔镜下阑尾切除术中两种阑尾残端的处理方法均安全有效,可吸收夹夹闭阑尾残端操作简单,手术时间更短,不会增加术后并发症风险,可作为推荐手术方法;腹腔镜下荷包包埋虽然可节省患者治疗费用,但对操作者要求较高,手术时间较长,术中需谨慎选择。

Objective To compare the clinical effects of purse-string suture and absorbable clip clamping for closing appendiceal stump in laparoscopic appendectomy.Methods A total of 525 patients of acute appendicitis who underwent laparoscopic appendectomy were selected and divided into the embedded group(appendiceal stump was closed by ligation and embedded by purse-string suture)and the unembedded group(appendiceal stump was clamped twice by absorbable clips)according to treatment of appendiceal stump during the surgery.The surgical treatment and the duration of operation,hospital stay,hospitalization cost,incidence of complications 1 month after operation of two groups were compared.Results Patients from both groups had successful laparoscopic appendectomy without severe postoperative complication.The duration of operation in the embedded group was longer than that in the unembedded group(t=8.313,P=0.001),the hospitalization cost in the unembedded group was significantly lower than that in the embedded group(t=2.591,P=0.013).There was no significant difference in the hospital stay or the incidence of postoperative complications(P>0.05).Conclusion In laparoscopic appendectomy,the two methods for closing appendiceal stump are safe and effective.The absorbable clip for clamping appendiceal stump in appendectomy can be recommended as an operative method because it is more simple to operate and has shorter operation time,and does not increase the risk of postoperative complications.Laparoscopic purse-string suture of the appendiceal stump can save the treatment cost of patients,but has high requirements for the operation,and takes a long time of operation,which should be discreetly selected during the operation.