Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.

Analysis of the Effectiveness of Laparoscopic Appendectomy Compared to Laparotomy in the Treatment of Acute Appendicitis

Objective:To analyze the clinical effects of laparoscopic appendectomy compared to traditional laparotomy in treating acute appendicitis.Methods:90 patients with acute appendicitis were selected as research subjects.They were divided into a control group and an observation group,with 45 cases in each group.The control group underwent traditional laparotomy,while the observation group underwent laparoscopic appendectomy.The intraoperative indicators,postoperative recovery indicators,postoperative stress indicators,and postoperative complications of the two groups were compared.Results:The operative time of the observation group was longer,but the incision length was shorter and the blood loss was lesser(P<0.05);the observation group had shorter postoperative first gas-passing time,recovery of gastrointestinal function,ambulation time,and lower postoperative pain score.The observation group had lower postoperative stress index levels(P<0.05);the observation group had a lower postoperative complication rate(P<0.05).Conclusion:Aside from prolonging the operative time,laparoscopic appendectomy is more ideal than traditional laparotomy in all other indicators and has better therapeutic effects in treating acute appendicitis.

Laparoscopic vs mini-incision open appendectomy

AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre.METHODS: The data of patients who underwen appendectomy between January 2011 and June 2013 were collected. The data included patients' demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale o pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded Patients with surgery converted from laparoscopic appendectomy(LA) to mini-incision open appendectomy(MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physica examination, laboratory values, and radiological tests(abdominal ultrasound or computed tomography). Al operations were performed with general anaesthesia The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients.RESULTS: Of the 243 patients, 121(49.9%) underwen MOA, while 122(50.1%) had laparoscopic appendectomy There were no significant differences in operation time between the two groups(P = 0.844), whereas the visua analog scale of pain was significantly higher in the open appendectomy group at the 1st hour(P = 0.001), 6th hour(P = 0.001), and 12 th hour(P = 0.027). The need for analgesic medication was significantly higher in the MOA group(P = 0.001). There were no differences between the two groups in terms of morbidity rate(P = 0.599)The rate of total complications was similar between the two groups(6.5% in LA vs 7.4% in OA, P = 0.599). Al wound infections were treated non-surgically. Six ou of seven patients with pelvic abscess were successfully treated with percutaneous drainage; one patient requiredsurgical drainage after a failed percutaneous drainage. There were no differences in the period of hospital stay, operation time, and postoperative complication rate between the two groups. Laparoscopic appendectomy decreases the need for analgesic medications and the visual analog scale of pain.CONCLUSION: The laparoscopic appendectomy should be considered as a standard treatment for acute appendicitis. Mini-incision appendectomy is an alternative for a select group of patients.

Laparoscopic appendectomy,stump closure and endoloops:A meta-analysis

BACKGROUND Acute appendicitis(AA)is one of the main indications for urgent surgery.Laparoscopic appendectomy(LA)has shown advantages in terms of clinical results and cost-effectiveness,even if there is still controversy about different devices to utilize,especially with regards to the endoloop(EL)vs endostapler(ES)when it comes to stump closure.AIM To compare safety and cost-effectiveness of EL vs ES.METHODS From a prospectively maintained database,data of 996 consecutive patients treated by LA with a 3 years-follow up in the department of Emergency General Surgery-St Orsola University Hospital,Bologna(Italy)were retrieved.A metaanalysis was performed in terms of surgical complications,in comparison to the international literature published from 1995 to 2021.RESULTS The meta-analysis showed no evidence regarding wound infections,abdominal abscesses,and total post-operative complications,in terms of superiority of a surgical technique for the stump closure in LA.CONCLUSION Even when AA is complicated,the routine use of EL is safe in most patients.

Laparoscopic versus Open Appendectomy Outcomes

Background: Appendicitis is one of the most common surgical emergencies requiring an appendectomy, with a life-time risk of 6%. The overall mortality rate for open appendectomy (OA) is around 0.3% and morbidity is about 11%. Objective: To compare laparoscopic vs open appendectomy with regard to postoperative pain and nausea, operative results, perioperative and postoperative complications, hospital admission. Methods: This prospective comparative study is performed in the Department of Surgery, North West Aramed Forced Hospital, Tabuk, Kingdom of Saudi Arabia. All patients between 13 and 60 years of age admitted through the accident and emergency (A&E) department with a clinical diagnosis of acute appendicitis and those who completed follow-up are included in the study. All those patients in whom a clinical diagnosis of acute appendicitis was not established or have a palpable mass in the right lower quadrant, suggesting an appendiceal abscess and those who does not give consent are excluded from the study. We reviewed the medical records of all patients who underwent a laparoscopic and open appendectomy in King Salman Armed Forces Hospital, Saudi Arabia from 1/1/2012 to 31/12/2015. Result: A total of 502 patients underwent Appendectomy at King Salman Armed Forces Hospital from 1/1/2012 till 31/12/2015. Of these, 203 were male (40.4%) and 299 were female (59.6%). The mean age was 18 years. Alvarado Score more than 7 in 93% of patients diagnosed with appendicitis. Comorbidities included diabetes 21 (5.56%) and hypertension 7 (1.39%). The mean Body Mass Index (BMI) was 20 kg/m2. 328 patients (65.3%) underwent Open Appendectomy (OA). None of Laproscopic appendectomy(LA) had a conversion. The mean operative time was 76 minutes (44 minutes and 50 minutes for OA and LA, respectively). Mean hospital stay in OA 2 days and one day LA. Eight cases (1.6%) developed seroma (6 cases in OA and 2 cases in LA with rates of 1.2% and 0.4% respectively). Nine patients (1.6%) had wound infection, 8 in OA and one in LA with rate of 1.5% and 0.2% respectively). Four patients (0.8%) develop the hematoma (3 cases in OA and one case in LA with rates of 0.6% and 0.2% respectively). Seven cases of reported appendectomy develop the pelvic abscess (1.4%) (5 cases in OA and 2 cases in LA with rates of 1% and 0.4% respectively). Conclusion: Alvarado Score carries high significance in the diagnosis of acute appendicitis. Laparoscopic appendectomy has improved diagnostic accuracy along with advantages in terms of fewer seroma, hematoma, wound infections, faster recovery, and earlier retention to normal activity but longer operative time.

Acute appendicitis: Epidemiology, treatment and outcomesanalysis of 16544 consecutive cases

AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA) in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants) from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year; mean age was 24.51 ± 16.17,54.7% were male and the mean Charlson's comorbidity index was 0.32 ± 0.92.Mortality was < 0.0001%.Appendectomy was performed in 94.7% of the patients and the mean length of stay was 5.08 ± 2.88 d; the cumulative hospital stay was 5.19 ± 3.36 d and 1.2% of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48% of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98 ± 3.96 d; the relapse rate was 23.1% and the cumulative hospital stay during the study period was 5.46 ± 6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach; conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results.

Is endoscopic retrograde appendicitis therapy a better modality for acute uncomplicated appendicitis? A systematic review and metaanalysis

BACKGROUND Previous studies had shown endoscopic retrograde appendicitis therapy(ERAT)is an effective treatment for acute appendicitis.However,different studies reported conflicting outcomes regarding the effectiveness of ERAT in comparison with laparoscopic appendectomy(LA).AIM To compare the effectiveness of ERAT with LA.METHODS Randomized controlled trials(RCTs)and retrospective studies of ERAT for acute uncomplicated appendicitis were searched in PubMed,Cochrane Library,Web of Science,Embase database,China National Knowledge Infrastructure(CNKI),the WanFang Database,and Chinese Scientific Journals Database(VIP)from the establishment date to March 12021.Heterogeneity was assessed using the Isquared statistic.Pooled odds ratios(OR),weighted mean difference(WMD),and standard mean difference(SMD),with 95%confidence intervals(CI)were calculated through either fixed-effects or random-effects model.Sensitivity analysis was also performed.Publication bias was tested by Egger's test,and Begg’s test.The quality of included RCT were evaluated by the Jadad scale,while Newcastle-Ottawa scale is adopted for assessing the methodological quality of case-control studies.All statistical analysis was performed using Stata 15.1 statistical software.All statistical analysis was performed using Stata 15.1 statistical software.This study is registered with PROSPERO,CRD42021243955.RESULTS After screening,10 RCTs and 2 case-control studies were included in the current systematic review.Firstly,the length of hospitalizations[WMD=-1.15,95%CI:-1.99,-0.31;P=0.007]was shorter than LA group.Secondly,the level of postoperative CRP[WMD=-10.06,95%CI:(-17.39,-2.73);P=0.007],TNF-α[WMD=-7.70,95%CI:(-8.47,-6.93);P<0.001],and IL-6 Levels[WMD=-9.78,95%CI:(-10.69,-8.88);P<0.001;P<0.001]in ERAT group was significantly lower than LA group.Thirdly,ERAT group had a lower incidence of intestinal obstruction than LA group.[OR=0.19,95%CI:(0.05,0.79);P=0.020].Moreover,the quality of 10 RCTs were low with 0-3 Jadad scores,while the methodological quality of two case-control studies were fair with a score of 2(each).CONCLUSION Compared with LA,ERAT reduces operation time,the level of postoperative inflammation,and results in fewer complications and shorter recovery time,with preserving the appendix and its immune and biological functions.

COVID-19 pandemic changed the management and outcomes of acute appendicitis in northern Beijing:A single-center study

BACKGROUND Since the outbreak of the coronavirus disease 2019(COVID-19)pandemic,outcomes and management of many diseases have been affected.Acute appendicitis is a common acute abdomen.The incidence rate is 0.05%-0.5%.Studies reported that the number of patients with appendicitis admitted to emergency department significantly decreased since the pandemic.People avoided going to the hospital for fear of being infected.Different countries have different epidemic prevention measures that result in different treatment outcomes.The Chinese government also published some temporary measures in order to prevent the outbreak.AIM To explore the changes in management and outcomes of acute appendicitis during the COVID-19 pandemic in the North of Beijing.METHODS Patients with acute appendicitis admitted to Beijing Tsinghua Changgung Hospital between February and June 2019 and February and June 2020 were retrospectively reviewed.Cases were grouped according to admission year.The demographic characteristics,present illnesses,medical history,symptoms and signs,comorbidities,blood test results,imaging data,appendix pathology,and treatment details were compared.RESULTS Overall,74 patients received nonsurgical treatment and 113 patients underwent surgical treatment in group 2019,whereas 159 patients received nonsurgical treatment and 26 patients received surgical treatment in group 2020.Fever,thick appendix,nonsurgical management,and uncomplicated appendicitis(simple or supportive appendicitis)were more common in group 2020(P<0.05).Among the nonsurgical management cases,the neutrophil percentage,neutrophil-tolymphocyte ratio,and recurrence rate were higher in group 2020(P<0.05).Among surgically managed cases,there were more cases with gastrointestinal symptoms,peritonitis,ascites in the image,and intraoperative adhesion or ascites in group 2020(P<0.05).The white blood cell count,time from diagnosis to surgery,surgical time,and intraoperative blood loss were higher in group 2020(P<0.05).CONCLUSION During the COVID-19 pandemic,patients suffering from acute appendicitis in Beijing tended to present with severe symptoms and opt for nonsurgical treatment.For patients who underwent surgical management,the operation was delayed and more difficult during the pandemic.Nevertheless,the hospital stay and the incidence of postsurgical complications did not change.

Samonella typhi infection-related appendicitis:A case report

BACKGROUND Acute appendicitis is one of the most common acute abdominal emergencies around the world,which is always associated with infection.Infection with Salmonella typhi,an enteric pathogen,is a rare cause of acute appendicitis.We here report a patient with acute appendicitis associated with Samonella typhi infection,accompanied with spleen and kidney infarction,providing a rare example for a common surgical emergency.CASE SUMMARY A 25-year-old Pakistani man presented to the hospital with a 3-d history of fevers,vomiting,and abdominal pain.Computed tomography(CT)revealed a thickened intestinal wall of the ileocecal junction with multiple enlarged lymph nodes nearby.He was diagnosed with acute appendicitis and received laparoscopic appendectomy,which showed mild inflammation of the appendix.After the surgery,the patient presented again with a high fever(>39℃)and diarrhea.A CT angiography scan indicated spleen and kidney infarction.According to the blood culture,the diagnosis was finally clear to be Samonella typhi infection.The pyrexia and enteric symptoms were relieved after the application of intravenous levofloxacin.CONCLUSION This case,characterized by the combination of Salmonella typhi infection,acute appendicitis,and renal and splenic infraction,serves as a rare example for a common surgical emergency.

小儿经脐单部位阑尾切除术与腹腔镜阑尾切除术的疗效对比

目的比较经脐单部位阑尾切除术与腹腔镜阑尾切除术治疗小儿急性阑尾炎的疗效。方法回顾性分析我科收治的162例14岁以下急性阑尾炎患儿的临床资料,根据手术不同将患儿分为经脐单部位手术组(n=59)与腹腔镜组(n=103)。记录患儿手术完成情况,比较2组患儿手术时间、术中出血量、胃肠道功能恢复时间、住院费用、住院时间、并发症发生情况等,观察患儿术后切口愈合情况。术后随访6个月,观察患儿切口感染、腹痛、腹胀、呕吐及大便异常等情况。结果腹腔镜组患儿手术均顺利完成,无中转开腹病例;经脐单部位组患儿有2例因查找阑尾困难,术中经脐部联用腹腔镜查找阑尾。经脐单部位手术组患儿手术时间、住院时间较均短于腹腔镜组(P<0.05)。2组患儿住院费用、术中出血量、胃肠道功能恢复时间、并发症发生率比较,差异无统计学意义(P>0.05)。经脐单部位手术组患儿术后切口愈合更美观。随访期间,2组患儿切口均愈合良好,并未出现腹痛、腹胀、呕吐及大便异常等。结论与传统腹腔镜阑尾切除术比较,经脐单部位阑尾切除术具有操作简单、手术时间和住院时间短、切口愈合更美观等优点。

单孔腹腔镜与传统腹腔镜在治疗儿童急性阑尾炎中的疗效对比研究

目的:比较单孔腹腔镜与传统三孔腹腔镜手术治疗儿童急性阑尾炎的效果。方法:回顾性分析2022年1—9月于南通大学附属医院小儿外科收治的急性阑尾炎患儿的临床资料,根据手术方法分为传统多孔腹腔镜阑尾切除术(conventional three-incision laparoscopic appendectomy,CLA)组(30例)和单孔腹腔镜阑尾切除术(single-incision laparoscopic appendectomy,SILA)组(30例),对两组患儿的术前一般资料、术后恢复情况及随访结果进行比较。结果:两组患儿在性别、年龄、BMI、WBC计数、CRP等术前一般资料,术后疼痛评分、住院时间、并发症发生率及住院总费用等方面,差异均无统计学意义(均P>0.05);SILA组手术时长较CLA组略高,但差异无统计学意义;SILA孔组的术后外观满意度明显优于CLA组(P<0.05)。结论:SILA与CLA临床疗效等同,在外观满意度上更具优势,是治疗儿童急性阑尾炎更为理想的手术方法。

内镜下逆行阑尾炎治疗术、腹腔镜阑尾切除术治疗急性阑尾炎脓肿患者的效果及对机体免疫功能的影响

目的对比内镜下逆行阑尾炎治疗术(ERAT)、腹腔镜阑尾切除术(LA)治疗急性阑尾炎(AA)脓肿患者的效果及对机体免疫功能的影响。方法回顾性分析2021年5月至2023年5月该院收治的80例AA脓肿患者的病历资料,按手术方案不同分A组和B组,每组40例。A组接受ERAT治疗,B组接受LA治疗。对比两组恢复指标水平(包括体温复常时间、下床活动时间、手术时间、胃肠功能恢复时间、术中失血量)、术前及术后1 d视觉模拟评分法(VAS)评分、胃肠激素[胃泌素(GAS)、血管活性肠肽(VIP)、胃动素(MTL)]、免疫功能(CD3^(+)T淋巴细胞比例、CD4^(+)T淋巴细胞比例、CD4^(+)/CD8^(+)比值)水平,以及并发症发生率。结果A组体温复常时间、下床活动时间、手术时间、胃肠功能恢复时间均短于B组,术中失血量少于B组,差异均有统计学意义(P<0.05);A组术后1 d VAS评分低于B组(P<0.05);A组术后1 d血清GAS、MTL水平高于B组,血清VIP水平低于B组,差异均有统计学意义(P<0.05);A组术后1 d CD3^(+)T淋巴细胞比例、CD4^(+)T淋巴细胞比例和CD4^(+)/CD8^(+)比值高于B组,差异均有统计学意义(P<0.05);A组并发症总发生率为2.50%(1/40),明显低于B组的20.00%(8/40),差异有统计学意义(P<0.05)。结论与LA相比,ERAT治疗AA脓肿患者的优势更为突出,不仅能进一步优化手术及术后恢复指标,减少并发症,减轻术后疼痛程度,且对机体胃肠及免疫功能影响更小。

ERAT与LA治疗成人急性无并发症性阑尾炎疗效及安全性的Meta分析

目的 比较内镜逆行阑尾炎治疗术(ERAT)和腹腔镜阑尾切除术(LA)治疗成人急性无并发症性阑尾炎的临床疗效及安全性差异。方法 检索PubMed、Cochrane Library、Web of Science、Embase、中国生物医学文献数据库(SinoMed)、中国知网(CNKI)、万方数据库和中国科学期刊数据库自建立之日起至2022年12月1日采用ERAT与LA治疗成人急性无并发症性阑尾炎的随机对照研究、回顾性研究和前瞻性研究。采用RevMan5.3软件对最终统计的数据进行Meta分析。采用统计量I2评估研究的异质性。通过固定效应或随机效应模型计算95%置信区间(CI)的优势比(OR)、加权平均差(WMD)。结果 ERAT组的手术时间(WMD=-19.46,95%CI:-27.36~-11.55,P<0.001)、术后体温恢复正常时间(WMD=-0.92,95%CI:-1.13~-0.71,P<0.001)、白细胞计数降至正常时间(WMD=-1.79,95%CI:-2.55~-1.02,P<0.001)、术后持续卧床时间(WMD=-1.77,95%CI:-2.34~-1.20,P<0.001)、术后住院时间(WMD=-2.77,95%CI:-3.63~-1.91,P<0.001)均短于LA组,且并发症(OR=0.26,95%CI:0.12~0.54;P=0.000 3)发生率更低。结论 相较于LA,ERAT治疗成人急性无并发症性阑尾炎更具优势。不仅减少了患者的痛苦,节约了医疗资源,还保留了阑尾的生物学功能,具有较大的临床推广及应用价值。

腹腔镜下经脐单部位阑尾切除术治疗小儿阑尾炎的效果及对炎症因子的影响

目的:探究腹腔镜下经脐单部位阑尾切除术治疗小儿阑尾炎的效果及对炎症因子的影响。方法:回顾性分析2022年3月至2023年6月期间我院就诊的阑尾炎患儿的临床资料,从接受腹腔镜下经脐单部位阑尾切除术的患儿中采用随机数字表法随机抽取55例纳入观察组,从接受采取传统腹腔镜阑尾切除术治疗的患儿中采用随机数字表法随机抽取50例纳入对照组。比较两组患儿的手术相关指标、术后恢复情况和术后并发症发生情况。并比较术前和术后5d的阑尾炎症状缓解情况[阑尾炎炎症反应(appendicitis inflammatory response,AIR)评分、视觉模拟评分法(visual analogue scale,VAS)评分],比较术前、术后48h和术后5d的炎症因子水平。结果:观察组患儿的手术时间、术中出血量、术后首次排气时间、体温恢复正常时间、下床活动时间、住院时间、术后并发症发生率均低于对照组,差异有统计学意义(P<0.05)。术后5d,两组患儿的AIR评分和VAS评分较术前降低,且观察组降低幅度大于对照组,差异有统计学意义(P<0.05)。重复测量方差分析显示两组患者术后的时点效应、组间效应及时点和组间的交互效应均可影响CRP、PCT、WBC水平的变化(P<0.05),且观察组低于对照组,差异有统计学意义(P<0.05)。结论:腹腔镜下经脐单部位阑尾切除术治疗小儿阑尾炎具有积极效果,减少术后并发症,降低炎症因子水平,有助于患儿快速恢复。

不同气腹压下的腹腔镜阑尾切除术对急性阑尾炎患儿应激反应、胃肠功能的影响

目的探讨急性阑尾炎患儿给予不同气腹压下的腹腔镜阑尾切除术(LA)对应激反应、胃肠功能的影响。方法选取2020年7月至2022年2月在九江市妇幼保健院接受LA治疗的90例急性阑尾炎患儿作为研究对象,采用随机数字表法分成A组(30例)、B组(30例)、C组(30例),A组术中二氧化碳(CO_(2))气腹压维持在8.0~9.0 mmHg,B组维持在>9.0~10.0 mmHg,C组维持在>10.0~11.0 mmHg,比较三组术野清晰度、应激反应及胃肠功能、局部疼痛。结果B组患儿的术野清晰度总优良率高于A组、C组,差异有统计学意义(P<0.017);A组、C组患儿术野清晰度总优良率比较,差异无统计学意义(P>0.017)。三组患儿T_(0)时的促肾上腺皮质激素(ACTH)、皮质醇(Cor)水平比较,差异无统计学意义(P>0.05);三组患儿T_(1)、T_(2)时的ACTH、Cor水平均高于本组T_(0)时,T_(2)时的ACTH、Cor水平均低于本组T_(1)时,差异有统计学意义(P<0.05);但B组T_(1)、T_(2)时的ACTH、Cor水平均低于A组、C组,差异有统计学意义(P<0.05);A组、C组T_(1)、T_(2)时的ACTH、Cor水平比较,差异无统计学意义(P>0.05)。B组患儿的肠鸣音恢复时间、肛门首次排气、排便时间均短于A组、C组,差异有统计学意义(P<0.05);A组、C组患儿肠鸣音恢复时间、肛门首次排气、排便时间比较,差异无统计学意义(P>0.05)。B组患儿局部疼痛评估总优良率高于A组、C组,差异有统计学意义(P<0.017);A组、C组患儿局部疼痛评估总优良率比较,差异无统计学意义(P>0.017)。结论急性阑尾炎患儿给予>9.0~10.0 mmHg气腹压下的LA,能够改善术野清晰度,促使胃肠功能恢复,对应激反应影响更小,局部疼痛感轻。

腹腔镜下阑尾切除术对急性阑尾炎患者术后并发症、炎性指标及康复效果分析

目的探讨腹腔镜下阑尾切除术对急性阑尾炎患者术后并发症、炎性指标及康复效果的影响。方法回顾性分析2023年1月至2024年1月本院阑尾切除手术的急性阑尾炎病例,按照手术方式不同,将实施开腹阑尾切除术的急性阑尾炎50例为对照组,实施腹腔镜下阑尾切除术的急性阑尾炎50例为研究组。关于两组病例各项临床指标作比较。结果研究组的手术耗时较对照组更长,术中失血量及术后并发症总发生率较对照组更低(均P<0.05)。研究组术后恢复肛门排气、恢复排便、初次离床活动的时间及住院天数均较对照组更短(均P<0.05)。研究组术后第1、2、3天的疼痛感评分均低于对照组(均P<0.05)。在术后1 d,研究组病例血清C反应蛋白和白细胞介素6水平均比对照组低(均P<0.05)。结论在急性阑尾炎患者进行手术治疗时,相比于应用开腹阑尾切除术,腹腔镜下阑尾切除术能够减少手术中血液的丢失量,减轻术后炎症反应和疼痛感,降低在手术后发生并发症的风险,从而促使手术后康复速度加快。

腹腔镜手术和开腹手术治疗急性阑尾炎的疗效对比分析

目的 对比腹腔镜手术和开放式手术治疗急性阑尾炎的疗效。方法 选取2021年1月—2023年4月本院普外科收治的急性阑尾炎患者180例为研究对象,采用随机分组方法将入组患者随机分为试验组(n=90)和对照组(n=90)。试验组采取腹腔镜阑尾切除术,对照组采取开腹阑尾切除术。记录两组患者手术时长、术后首次排气时间、抗菌药物应用时长、术后住院时间、术后疼痛等主要观察指标,以及切口感染、肠粘连、腹腔脓肿等术后并发症发生率,经分析后对比两组手术方式疗效。结果 试验组患者的手术时长、术后首次排气时间、抗菌药物应用时长、术后住院时间短于对照组(P<0.05);术后疼痛程度低于对照组(P<0.05);术后并发症的总发生率低于对照组(P<0.05)。结论 腹腔镜阑尾切除术治疗急性阑尾炎患者,能有效缩短手术时长、住院时间,减轻患者术后疼痛,患者术后胃肠道功能恢复较早,并发症发生率低,安全性更高。

穿孔坏疽阑尾炎患者行开腹和腹腔镜下阑尾炎手术治疗的效果分析

目的 探讨穿孔坏疽阑尾炎患者行开腹和腹腔镜下阑尾炎手术治疗的效果。方法 84例穿孔坏疽阑尾炎患者,随机分为观察组与对照组,各42例。对照组使用常规开腹手术治疗,观察组使用腹腔镜下阑尾炎手术治疗。比较两组各项手术指标、并发症发生情况、炎症及应激反应指标、世界卫生组织生存质量量表(WHOQOL-100)评分。结果 观察组手术时间(58.67±6.20)min、术后排气时间(25.16±5.42)h、下床活动时间(8.31±2.04)h、住院时间(6.21±1.68)d均短于对照组的(71.35±8.48)min、(52.37±7.89)h、(24.84±4.03)h、(12.57±3.03)d,术中出血量(24.38±4.16)ml少于对照组的(64.73±9.51)ml,术后1 d的视觉模拟评分法(VAS)评分(2.42±0.65)分低于对照组的(5.18±1.02)分(P<0.05)。观察组并发症发生率4.76%低于对照组的23.81%(P<0.05)。观察组术后24 h的降钙素原(PCT)(0.62±0.20)μg/L、C反应蛋白(CRP)(22.91±4.35)mg/L、肿瘤坏死因子-α(TNF-α)(47.83±11.76)μg/L、皮质醇(Cor)(54.64±7.72)μg/dl均低于对照组的(1.39±0.24)μg/L、(31.83±5.72)mg/L、(75.14±14.59)μg/L、(126.43±13.51)μg/dl(P<0.05)。观察组术后1周的生理领域、独立性领域、社会关系领域、心理领域、环境领域评分分别为(4.03±0.22)、(4.10±0.24)、(4.14±0.23)、(4.12±0.28)、(4.17±0.29)分,均高于对照组的(2.97±0.28)、(3.01±0.27)、(3.04±0.25)、(2.95±0.24)、(3.06±0.25)分(P<0.05)。结论 穿孔坏疽阑尾炎患者行腹腔镜下阑尾炎手术治疗的效果更好,术后炎症及应激反应程度轻,恢复快,并发症发生率低,有助于快速提高生活质量,具有积极的临床意义。

腹腔镜阑尾切除术后切口感染发生情况及高危因素分析

目的探讨急性阑尾炎(AA)患者行腹腔镜阑尾切除术(LA)治疗后切口感染发生情况及其影响因素。方法回顾性分析542例AA患者的临床资料,均行LA进行治疗,依据术后是否发生切口感染分为非感染组(n=462)与感染组(n=80)。采用调查问卷调查两组一般资料,并采取单因素分析、多因素Logistic回归分析法,分析LA术后发生切口感染的高危因素。结果542例患者中,共发生切口感染80例,切口感染发生率为14.76%(80/542)。单因素分析显示,感染组年龄>50岁、病程>24 h、病理类型为化脓性或坏疽穿孔性阑尾炎、合并基础疾病、手术时间>1.5 h及有吸烟史占比分别为67.5%(54/80)、66.3%(53/80)、72.5%(58/80)、62.5%(50/80)、68.8%(55/80)、36.3%(29/80),均高于非感染组的44.8%(207/462)、31.0%(143/462)、24.9%(115/462)、27.1%(125/462)、35.1%(162/462)、21.9%(101/462)(P<0.05)。多因素Logistic回归分析显示,年龄>50岁、病程>24 h、病理类型为化脓性或坏疽穿孔性阑尾炎、合并基础疾病、手术时间>1.5 h及有吸烟史均是导致AA患者行LA术后发生切口感染的高危因素(P<0.05)。结论年龄、病程、病理类型、合并基础疾病、手术时间及吸烟史均是导致AA患者术后切口感染发生的影响因素,临床护理过程中应加以重视,并开展相应的干预措施。

复杂性急性阑尾炎腹腔镜术后并发肠梗阻的影响因素及其预测价值分析

目的研究复杂性急性阑尾炎(complicated acute appendicitis,CAA)患者腹腔镜阑尾切除术后并发肠梗阻(postoperative ileus,POI)的影响因素。方法回顾性收集2022年9月—2023年12月就诊于郑州市中心医院的CAA患者临床资料,根据腹腔镜阑尾切除术后临床症状和影像学分为POI组和非POI组。采用Logistic回归分析CAA患者术后并发POI的影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线探究相关指标的预测价值。结果共纳入153例CAA患者,其中POI组15例,非POI组138例。单因素分析结果显示,POI组与非POI组在年龄、腹部手术史、术前全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)、白细胞计数(white blood cell,WBC)、白蛋白计数(albumin,ALB)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)和术后留置引流管的差异有统计学意义(P<0.05)。Logistic回归分析结果显示,术前SIRS[OR=31.212,95%CI(2.012,484.090),P<0.05]、WBC升高[OR=1.328,95%CI(1.048,1.682),P<0.05]和NLR升高[OR=1.430,95%CI(1.114,1.837),P<0.05]是CAA患者腹腔镜阑尾切除术后并发POI的危险因素,ALB升高[OR=0.734,95%CI(0.565,0.953),P<0.05]是术后并发POI的保护因素。ROC曲线分析结果显示,WBC、NLR、ALB预测CAA患者术后并发POI的曲线下面积分别为0.842[95%CI(0.756,0.927),P<0.001]、0.904[95%CI(0.831,0.978),P<0.001)、0.845[95%CI(0.734,0.956),P<0.001]。结论CAA患者术前合并SIRS、高WBC、高NLR、低ALB会增加腹腔镜阑尾切除术后并发POI的风险,WBC、NLR、ALB对CAA患者腹腔镜阑尾切除术后并发POI具有较高的预测价值。