腹腔镜阑尾切除术中不同阑尾根部处理方式对患者术后康复的影响

Effect of different appendix stump treatments on postoperative rehabilitation in laparoscopic appendectomy

目的 分析腹腔镜阑尾切除术(LA)中采用不同阑尾根部处理方式对患者术后康复的影响。方法 回顾性收集2020年7月~2021年7月在本院普外科因急性化脓性阑尾炎行LA治疗的63例患者资料,根据术中阑尾根部处理方式不同分为A组(30例)和B组(33例)。A组阑尾根部单纯结扎或夹闭, B组阑尾根部结扎后荷包缝合包埋。比较两组手术及术后康复情况、生活质量、并发症情况及远期疼痛程度。结果 A组手术时间、肛门排气时间、肠功能恢复时间、排便时间以及住院费用分别为(57.17±19.06)min、(1.83±0.69)d、(2.37±0.62)d、(2.93±0.91)d、(10971.43±1727.95)元,与B组的(60.76±23.09)min、(1.76±0.44)d、(2.21±0.60)d、(2.60±0.93)d、(11648.02±1623.59)元比较无显著差异(P>0.05)。两组术后1个月、3个月、半年、1年生活质量评分比较无显著差异(P>0.05)。A组、B组并发症发生率为3.33%、3.03%比较无显著差异(P>0.05)。两组远期疼痛程度比较无显著差异(P>0.05)。结论 LA中阑尾根部单纯结扎或夹闭、结扎后荷包缝合包埋两种阑尾根部处理方式对患者术后康复均有较好的疗效,手术过程中应综合考虑患者阑尾根部炎症情况、解剖位置、腔镜手术器械条件、术者技能等因素决定急性化脓性阑尾炎患者LA中阑尾根部的处理方式。

Objective To analyze the effect of different appendix stump treatments on postoperative rehabilitation in laparoscopic appendectomy(LA).Methods 63 patients undergoing LA due to acute suppurative appendicitis treated in the general surgery department of our hospital from July 2020 to July 2021 were retrospectively collected,and divided into group A(30 cases)and group B(33 cases)according to different appendix stump treatments.Appendix stump in group A was simply ligated or clipped,and appendix stump in group B was ligated and embedded with purse-string suture.Operation and postoperative rehabilitation,quality of life,complications and long-term pain degree were compared between the two groups.Results The operative time,anal exhaust time,intestinal function recovery time,defecation time and hospitalization expenses of group A were(57.17±19.06)min,(1.83±0.69)d,(2.37±0.62)d,(2.93±0.91)d and(10971.43±1727.95)yuan,and those of group B were(60.76±23.09)min,(1.76±0.44)d,(2.21±0.60)d,(2.60±0.93)d and(11648.02±1623.59)yuan;with no significant difference(P>0.05).At postoperative 1 month,3 months,6 months and 1 year,there was no significant difference in quality of life scores between the two groups(P>0.05).The complication rates of the two groups were 3.33%and 3.03%respectively,with no significant difference(P>0.05).There was no significant difference in long-term pain intensity between the two groups(P>0.05).Conclusion During LA,both simple ligation or clipping of the appendix stump and purse-string suture and embedding after ligation have good effects on the postoperative rehabilitation of patients.During the operation,the inflammation of the appendix stump,anatomical location,conditions of endoscopic surgical instruments,and operator skills should be comprehensively considered to determine the treatments of the appendix stump in LA for patients with acute suppurative appendicitis.