腹腔镜阑尾切除术阑尾残端两种处理方法的对比研究

目的:对比研究腹腔镜阑尾切除术(laparoscopic appendectomy,LA)中阑尾残端的两种处理方法。方法:2004年7月至2013年6月为216例患者行LA,将其随机分为夹闭组(n=86)与荷包组(n=130),夹闭组在处理阑尾系膜后采用钛夹或高分子结扎钉直接夹闭阑尾残端;荷包组处理阑尾系膜后缝扎阑尾残端,并荷包缝合包埋。对比分析两组手术时间、术中出血量、术后肠功能恢复时间、术后住院时间及并发症发生率。结果:两组患者手术过程顺利,无中转开腹及严重并发症发生。夹闭组手术时间短于荷包组(27±9)min vs.(38±12)min,P=0.04];术中出血量(12±6)ml vs.(14±7)ml,P=0.17]、术后肠功能恢复时间(26±8)h vs.(28±9)h,P=0.25]及术后住院时间(2.7±1.8)d vs.(2.9±1.6)d,P=0.14]两组差异无统计学意义;夹闭组中8例出现下腹不适,3例术后出现腹痛,5例出现术后发热,1例行二次手术;荷包组中3例出现下腹不适,1例术后腹痛,2例出现术后发热,无二次手术。夹闭组术后并发症发生率(19.8%vs.4.6%,P<0.01)及粘连性肠梗阻发生率(8.1%vs.3.1%,P<0.01)显著高于荷包组。结论:应用荷包包埋法处理阑尾残端手术时间略长,但术后并发症发生率低,是LA术中阑尾残端安全的处理方法。

Comparison study of two approaches for treatment of the appendicular stump during laparoscopic appendectomy

Objective：To compare the two approaches for treatment of the appendicular stump during iaparoscopic appendecto- my. Methods：Totally 216 patients received laparoscopic appendectomy from Jul. 2004 to Jun. 2013, they were randomly divided into clamping group （n = 86） and purse-string suture group （n = 130）. For patients of clamping group, appendicular stump was clamped by titanium clip or Hem-o-lok during the procedure, while in purse-string suture group, appendicular stump was embeded with purse-string suture after mesenteriolum was cut off. Then data of both groups were collected and analyzed,including operation time, amount of bleed- ing, intestinal function recovery time, hospital stay after operation and complications. Results： All operations of both groups went smooth- ly,no conversion or severe complications occurred. No difference existed in amount of bleeding （ 12± 6） ml vs. （ 14±7 ） ml,P = 0.17 ], intestinal function recovery time （26± 8 ） h vs. （28 ± 9 ） h, P = 0.25 ] and hospital stay after operation （2.7 ±1.8 ） d vs. （2.9 ±1.6） d, P = 0.14 ] between two groups. Clamping group showed significantly shorter operation time than purse-string suture group （27 ± 9 ） min vs. （ 38±12 ） rain, P=0.04 ]. There were 8 cases of lower abdominal discomfort, 3 cases of abdominal pain, 5 cases of fever and 1 re-operation in clamping group, and 3 cases of lower abdominal discomfort, 1 case of abdominal pain,2 cases of fever in purse-string suture group. More postoperative complications （ 19.8% vs. 4.6% ,P 〈0.01 ） and adhesive ileus （8.1% vs. 3.1% ,P 〈 0.01 ） were found in clamping group compared with purse-string suture group. Conclusions：Although spending a little longer operation time, treatment of the appendicular stump using purse-string suture is a safe approach with lower postoperative complications during laparoscopic appendectomy.