小儿腹腔镜阑尾切除术的临床评价

Clinical value analysis of laparoscopic appendectomy in children

目的 评价小儿腹腔镜阑尾切除术 (laparoscopicappendectomy ,LA)的效果。 方法 对比分析LA组 (n =89)和开腹阑尾切除术 (openappendectomy,OA)组 (n =90 )的手术效果、住院时间、费用支出和患者满意程度。 结果 LA组较OA组手术时间显著延长 [(5 7± 2 )minvs (43± 1)min ,t=6 2 82 ,P =0 0 0 0 ],总医疗费用显著降低 [(15 2 91± 4 99)元vs.(174 4 2±5 4 4 )元 ,t=- 2 912 ,P =0 0 0 4 ],住院时间显著缩短 [(2 9± 0 2 )dvs.(3 6± 0 2 )d ,t=- 2 4 75 ,P =0 0 14 ],两组手术并发症发生率和病人满意度调查无明显差别 (χ2 =0 119,P =0 730 ;χ2 =0 4 35 ,P =0 5 0 9)。 结论 两种术式同样有效 ,LA不增加医疗费用 ,LA微创特点和探查腹腔更具优越性 ,提倡用于小儿阑尾炎。

Objective To compare the laparoscopic appendectomy (LA) and the open appendectomy (OA) in children at all points of the clinical value compass. Methods A series of 398 children undergoing an emergency appendectomy had been studied prospectively from January 1999 to October 2000. The determination of operation, LA or OA, was depended on whether qualified surgeons were available and choices of children’s parents. There were no statistical differences in gender and types of appendicitis between the Group LA (n=89) and the Group OA (n=90). Random independent patient satisfaction surveys were collected prior to discharge. Surgical audit data were utilized for evaluating the occurrence of complications. Results Compared with the Group OA, the operating time in the Group LA was significantly longer [(57±2)min vs (43±1)min; t =6.282, P =0 000], the total costs in the Group LA was significantly lower[(15 291±499) yuan vs (17 442±544) yuan ; t =-2 912, P =0 004], and the hospital stay in the Group LA was significantly shorter[(2 9±0 2) days vs (3 6±0 2) days; t =-2 475, P =0 014]. The differences between the two groups in the occurrence of complications and patients’ satisfaction were not statistically significant( χ 2=0 119,P=0 730; χ 2=0 435,P=0 509 ). Conclusions Both of the two procedures are effective. LA does not increase the total costs and is recommended for children by virtue of minimal invasion and complete abdominal exploration.