单纯缝合与荷包缝合包埋处理腹腔镜阑尾切除术中复杂阑尾残端的效果分析

Effect analysis between simple suture and purse-string suture embedding in the treatment of complex appendiceal stump during laparoscopic appendectomy

目的 对比分析单纯缝合与荷包缝合包埋在腹腔镜手术复杂阑尾残端处理中的应用效果。方法 回顾性收集102例接受急诊腹腔镜手术治疗的阑尾根部炎症较重的急性阑尾炎患者的临床资料,根据手术方式将其分为荷包缝合包埋组和单纯缝合组,并应用Logistic回归模型进行倾向性评分匹配分析。对比倾向性评分匹配后两组患者的手术时间、术中出血量、术后并发症(阑尾残端瘘、切口感染以及腹腔残余感染)发生情况、术后肛门首次排气时间、腹腔引流管留置时间以及住院时间。结果 两组患者经倾向性评分匹配成功匹配33对。单纯缝合组患者的手术时间短于荷包缝合包埋组,但荷包缝合包埋组患者腹腔引流管留置时间短于单纯缝合组(均P<0.05)。两组患者的术中出血量、术后并发症发生率、术后肛门首次排气时间、住院时间差异均无统计学意义(均P>0.05)。结论 对于阑尾根部炎症较重的急性阑尾炎患者,采用单纯缝合与荷包缝合包埋处理阑尾残端均安全有效,单纯缝合的操作更便捷,手术时间相对较短。而荷包缝合包埋更符合术后机体的生理性修复过程。

Objective To make a comparative analysis of the application effects of simple suture and purse-string suture embedding in the treatment of complex appendiceal stump in laparoscopic surgery.Methods The clinical data of 102 acute appendicitis patients with severe inflammation at the root of the appendix who received emergency laparoscopic surgery were retrospectively collected,and they were divided into purse-string suture embedding group and simple suture group according to the surgical method,and the propensity score matching analysis was performed by Logistic regression model.After propensity score matching,the operation time,intraoperative blood loss,occurrence of postoperative complications(appendiceal stump fistula,incision infection and abdominal residual infection),first anal exsufflation time after surgery,indwelling duration of abdominal drainage tube and hospital stay were compared between the two groups.Results Thirty-three pairs of patients in the two groups were successfully matched by propensity score matching.The operation time in the simple suture group was shorter than that in the purse-string suture embedding group,while the indwelling duration of abdominal drainage tube in the purse-string suture embedding group was shorter than that in the simple suture group(all P<0.05).There were no statistically significant differences in the intraoperative blood loss,incidence of postoperative complications,first anal exsufflation time after surgery and hospital stay between the two groups(all P>0.05).Conclusion For patients with acute appendicitis with severe inflammation of the appendiceal root,simple suture and purse-string suture embedding are both safe and effective in the treatment of appendiceal stump,while the operation of simple suture is more convenient and the operation time is relatively short.Nevertheless,purse-string suture embedding is more in line with the physiological repair process of the body after operation.