腹腔镜与开腹手术治疗急性阑尾炎穿孔的比较

目的：探讨腹腔镜治疗急性阑尾炎穿孔的效果和价值。方法回顾性分析2010年1月～2011年2月我院由同一组高年资医师完成的77例穿孔性阑尾炎手术的临床资料，其中腹腔镜阑尾切除术（laparoscopic appendectomy， LA）35例（LA组），开腹阑尾切除术（open appendectomy， OA）42例（OA组），比较2组手术时间、肠道功能恢复时间、切口感染率、腹腔脓肿发生率、住院时间、住院费用。结果2组手术时间无显著性差异[（64．1±18．1） min vs．（65．1±13．8） min，t＝0.275，P＝0．784]；腹腔脓肿发生率无显著差异[2．9％（1/35） vs．4．8％（2/42），χ2＝0．000，P＝1．000]。与OA组相比，LA组切口感染率显著降低[5．7％（2/35） vs．26．2％（11/42），χ2＝5．704，P＝0．017]；肠功能恢复时间明显缩短[（26．1±4．6）h vs．（36．1±11．9）h， t＝-4．684，P＝0．000）；住院时间明显缩短[（7．1±2．8）d vs．（9．2±4．8）d， t＝-2．283，P＝0．025]；住院费用显著升高[（12．6±2．2）千元vs．（8．1±2．9）千元，t＝7．545，P＝0．000]。结论腹腔镜经验丰富的外科医生应用腹腔镜治疗穿孔性阑尾炎有显著优势，手术费用的增加是唯一缺点。

Comparison of Laparoscopic Appendectomy and Open Appendectomy for Perforated Acute Appendicitis

Objective To evaluate the clinical effect of laparoscopic appendectomy （ LA） for the treatment of perforated acute appendicitis. Methods The data of 77 cases of perforated acute appendicitis undergoing LA or open appendectomy （OA） by the same senior surgeon group were retrospectively analyzed , including 35 cases of LA （LA group） and 42 cases of OA （OA group）.The operation time , intestinal function recovery time , incision infection rate , incidence of abdominal abscess , hospital costs , and hospital stay were compared between the two groups . Results No difference was found in operative time between the two groups [（64.1 ± 18.1） min vs.（65.1 ±13.8） min, t=0.275, P=0.784].No difference was found in the incidence of abdominal abscess [2.9%（1/35） vs.4.8%（2/42）,χ2 =0.000,P=1.000] between the two groups.Compared with the OA group, the incision infection rate was significantly lower in LA group [5.7%（2/35） vs.26.2%（11/42）,χ2 =5.704,P=0.017].The intestinal function recovery time [（26.1 ±4.6） h, vs.（36.1 ±11.9） h, t=-4.684, P=0.000] and hospital stay [（7.1 ±2.8） d vs.（9.2 ±4.8） d, t=-2.283, P=0.025] were significantly shorter in LA group than in OA group .The hospital costs in LA group were significantly higher than in OA group [（12.6 ±2.2） ×103 yuan vs.（8.1 ±2.9） ×103 yuan, t=7.545, P=0.000]. Conclusions LA is superior to OA for the treatment of perforated acute appendicitis .The only disadvantage of LA is the increased hospital costs .