肥胖患者行腹腔镜与开腹阑尾切除术疗效的对比研究

目的 对比分析肥胖患者行腹腔镜与开腹阑尾切除术的临床效果.方法 回顾性分析2008-2010年因急性阑尾炎在中国医科大学附属盛京医院行阑尾切除术的肥胖患者153例的临床资料.153例中,腹腔镜阑尾切除术92例(其中4例转为开腹),开腹阑尾切除术61例,对两种术式的手术时间、术中出血量、术后排气时间、术后止痛药使用频率、术后主要并发症的发生率、住院时间和住院费用进行比较.计数资料比较采用x2检验,计量资料采用t检验.结果 腹腔镜阑尾切除术组在手术时间、术中出血量、术后排气时间、术后止痛药使用频率、术后主要并发症的发生率、住院时间方面均短于或少于开腹阑尾切除术组,差异有统计学意义(手术时间:t=14.0,P＜0.01;术中出血量:t =19.7,P＜0.01;术后排气时间:t=12.3,P＜0.01;术后止痛药使用频率:t=21.01,P＜0.01;术后主要并发症的发生率:x2=40.138,P＜0.01;住院时间:t=17.3,P＜0.01).两者在住院总花费上的差异无统计学意义(=1.434,P =0.154).结论 肥胖患者行腹腔镜阑尾切除术治疗阑尾炎与开腹阑尾切除术相比具有创伤小、恢复快、并发症少和平均住院时间短等优点,是治疗肥胖阑尾炎患者理想的手术方式.     

��������β���и�ǻ���뿪����������Ч�Աȷ���

目的　对比分析腹腔镜和开腹阑尾切除术在治疗穿孔性阑尾炎中的手术效果。方法　 2 0 0 0年 1月至 2 0 0 4年 1月行阑尾切除术治疗穿孔性阑尾炎 12 8例 ,其中腹腔镜阑尾切除术 5 6例 ,开腹阑尾切除术 72例。比较两种术式的手术时间、下床活动时间、术后排气时间、疼痛评分、止痛药使用率、切口感染率、置管引流率、残余脓肿发生率、住院时间和综合费用。结果　比较腹腔镜阑尾切除术组和开腹阑尾切除术组以上各指标 (除手术时间和综合费用外 )差异均有显著意义 (P <0 .0 5 )。结论　腹腔镜阑尾切除术治疗穿孔性阑尾炎和开腹阑尾切除术相比 ,具有创伤小、恢复快、并发症少和平均住院时间短等优点 ,是治疗穿孔性阑尾炎较理想的手术方式。     

急性阑尾炎行腹腔镜手术与开腹手术的比较

目的对比分析腹腔镜与开腹阑尾切除术在治疗急性阑尾炎中的手术效果。方法回顾性分析2009年1月至2011年10月58例行腹腔镜阑尾切除术（LA组）和同期55例行开腹阑尾切除术（OA组）的急性阑尾炎患者的临床资料,比较两种术式手术时间、下床活动时间、术后排气时间、止痛药物使用率、并发症发生率、住院时间及综合费用等指标。结果 LA组与OA组相比上述指标除手术时间外差异均有统计学意义（P〈0.05）。结论腹腔镜阑尾切除术治疗急性阑尾炎具有创伤小、恢复快、并发症少和住院时间短等优点,可作为治疗急性阑尾炎的理想选择。     

急性阑尾炎腹腔镜下阑尾切除术疗效观察

目的分析腹腔镜阑尾切除术治疗急性阑尾炎的临床疗效。方法将80例符合手术指征的急性阑尾炎患者随机分为对照组(行传统开腹手术)和腹腔镜组(腹腔镜阑尾切除术)两组,每组40例。比较两组平均手术时间、术后并发症、术后排气时间及住院时间。结果两组术后并发症、术后排气及住院时间差异有统计学意义(P0.05),平均手术时间差异无统计学意义(P0.05)。结论腹腔镜阑尾切除术治疗急性阑尾炎术后并发症发生率及住院时间均优于开腹手术。     

腹腔镜与开腹手术治疗小儿急性阑尾炎的对比研究

目的：对比腹腔镜与开腹手术治疗小儿复杂急性阑尾炎的临床疗效。方法：2004年1月至2009年1月收治小儿复杂阑尾炎253例,分别行腹腔镜阑尾切除术（laparoscopic appendectomy,LA）123例,开腹阑尾切除术（open appendectomy,OA）130例,比较两组术中出血量、恢复进食时间、术后住院时间、抗生素使用时间及术后并发症。结果：LA组术中出血量、恢复进食时间、腹腔引流管拔除时间、术后住院时间、抗生素使用时间均明显少于OA组,LA组术后切口感染、肠梗阻、腹腔脓肿发生率低于OA组。结论：腹腔镜治疗小儿复杂急性阑尾炎的疗效明显优于开腹手术。     

腹腔镜与开腹手术治疗小儿复杂阑尾炎的疗效对比分析

目的:对比分析复杂阑尾炎患儿行腹腔镜阑尾切除术与开腹手术的临床疗效。方法:选取2015年1月至2017年10月收治的60例复杂阑尾炎患儿作为研究对象,纳入患儿家属签署知情同意书,按入组奇偶顺序分为腹腔镜组(偶数)与开腹组(奇数),每组30例,腹腔镜组行腹腔镜阑尾切除术,开腹组行开腹阑尾切除术。记录两组手术时间、术中出血量、并发症发生情况、术后恢复进食时间、住院时间。结果:腹腔镜组手术时间、术中出血量、术后恢复进食时间、住院时间、并发症发生率均优于开腹组(P0.05)。结论:腹腔镜阑尾切除术治疗小儿复杂阑尾炎并发症发生率低,术后康复快,可有效缩短住院时间,可考虑作为小儿复杂阑尾炎的首选术式。     

急性阑尾炎患者实施腹腔镜阑尾切除术的疗效观察

目的分析急性阑尾炎腹腔镜阑尾切除术的疗效。方法将72例急性阑尾炎患者随机分为2组,各36例。对照组行开腹阑尾切除术,观察组行腹腔镜阑尾切除术。比较2组手术时间、术中出血量、术后肛门排气时间及切口感染率和术后住院时间。结果 2组均顺利完成手术,观察组无中转开腹手术。2组手术时间差异无统计学意义(P0.05)。观察组术中出血量、术后肛门排气时间、切口感染率及术后住院时间均少于对照组,差异均有统计学意义(P0.05)。结论腹腔镜阑尾切除术治疗急性阑尾炎,创伤小、并发症少、患者术后恢复快。     

急性阑尾炎腹腔镜阑尾切除术疗效观察

目的对比分析腹腔镜及开腹阑尾切除术治疗急性阑尾炎的效果。方法随机将76例急性阑尾炎患者分为2组,每组38例。观察组行腹腔镜手术,对照组实施开腹手术。比较2组手术时间、术后下床时间、切口感染率、腹腔残余脓肿发生率及住院时间。结果治疗组术后下床时间、住院时间均短于对照组,切口感染率低于对照组,2组比较,差异有统计学意义(P0.05)。2组患者手术时间、腹腔残余脓肿发生率比较,差异无统计学意义(P0.05)。结论腹腔镜阑尾切除术创伤小、并发症少、患者术后恢复快。     

腹腔镜阑尾切除术临床价值再探讨

目的再次探讨腹腔镜阑尾切除术的手术价值。方法收集川北医学院附属医院普通外科2009年4月至2010年12月期间收治的已行阑尾切除术的阑尾炎患者共200例的临床资料,比较行腹腔镜阑尾切除术(腹腔镜组)和开腹阑尾切除术(开腹组)患者的手术时间、术后住院时间、住院费用、术后肛门排气时间、术后疼痛得分、手术并发症等。结果腹腔镜组8例患者中转开腹。腹腔镜组住院费用高于开腹组(P<0.05);慢性阑尾炎、急性单纯性阑尾炎、发病36 h内的急性化脓性阑尾炎在腹腔镜组较开腹组手术时间短、术后住院时间短、肛门排气时间较早、术后疼痛轻(P<0.05);超过36 h的急性化脓性阑尾炎及急性坏疽性阑尾炎2组在术后住院时间、肛门排气时间、术后疼痛方面差异均无统计学意义(P>0.05);急性坏疽性阑尾炎在腹腔镜组手术时间较开腹组长(P<0.05),但腹腔镜组切口感染率较开腹组低(P<0.05)。结论慢性阑尾炎、急性单纯性阑尾炎、发病36 h内的急性化脓性阑尾炎经腹腔镜阑尾切除术治疗效果确切,优点突出,应用价值明确;而对于发病超过36 h的急性化脓性阑尾炎及急性坏疽性阑尾炎腹腔镜阑尾切除术手术操作困难,中转率高,术后恢复较开腹手术没有明显优势,并且增加了医疗费用,应用价值不大。     

腹腔镜与开腹阑尾切除术治疗急性阑尾炎的疗效对比分析

目的比较腹腔镜和开腹阑尾切除术治疗急性阑尾炎的手术效果及其优缺点。方法回顾性分析2013年1月至2014年12月期间在笔者所在医院科室行阑尾切除术的急性阑尾炎患者的资料,纳入研究患者201例,分为腹腔镜组(102例)和开腹组(99例),比较2组患者手术中以及手术后的相关临床指标。结果腹腔镜组和开腹组患者术前基线特征比较差异无统计学意义(P0.05),具有可比性。腹腔镜组患者的手术时间、术后肠道功能恢复时间、下床活动时间以及住院时间短于开腹组,但住院费用高于开腹组,差异均有统计学意义(P0.05);同时,2组患者的腹腔感染率、腹腔引流率及30 d内再入院率相近,差异无统计学意义(P0.05)。多因素回归分析结果显示,阑尾穿孔及腹腔镜手术能够增加腹腔引流率〔OR=2.710,95%置信区间(1.129,6.507),P=0.026〕。结论腹腔镜手术和开腹手术都是治疗急性阑尾炎安全有效的方法。但与开腹阑尾切除术相比,腹腔镜阑尾切除术具有手术时间短、切口感染率低、术后下床时间早、肠道功能恢复快和住院时间短的优势,尽管住院费用更高,仍可作为急性阑尾炎的首选方法。此外,腹腔镜阑尾切除术是影响腹腔引流的独立危险因素。     

Laparoscopic appendectomy is superior to open appendectomy in obese patients

BACKGROUND: There are minimal data comparing laparoscopic appendectomy (LA) with open appendectomy (OA) in obese patients. METHODS: We reviewed consecutive adult patients from 2003 to 2005 who underwent an appendectomy at a University-affiliated teaching hospital. Obesity was defined as a body mass index of 30 or greater. Outcome measures included length of stay, surgical times, intra-abdominal abscesses, wound infections, and hospital charges. RESULTS: There were 116 patients with a mean body mass index of 35. Eighty-five patients underwent LA, 12 were converted to open, 4 of 12 (31%) were perforated. Thirty-one patients underwent OA. Overall, 21 (18%) were perforated. Length of stay for LA was better, 3.4 days versus 5.5 days for OA (P = .02), and wound closure rate was better, 90% for LA versus 68% for OA (P < .01). Other outcome measures were equivalent. CONCLUSIONS: LA is associated with shorter lengths of stay, fewer open wounds, and equivalent hospital charges and intra-abdominal abscess rates; and should be considered the procedure of choice for obese patients with appendicitis.     

急性阑尾炎行腹腔镜手术与传统开腹手术的比较

目的对比急性阑尾炎经腹腔镜切除与传统开腹切除的手术效果及优缺点。方法对2004年2月~2004年12月临床诊断为急性阑尾炎的病人123例,其中行腹腔镜手术59例,开腹手术64例。比较两种术式的手术时间,术后下床活动时间,术后进食时间,术后出院时间,止疼药使用率,其他器官探查阳性率及综合费用。结果通过比较两种术式的以上各指标,腹腔镜手术组有明显的优势。结论急性阑尾炎经腹腔镜手术具有创伤小、疼痛轻、恢复快、住院时间短及美容等优点,是治疗急性阑尾炎理想的手术方式。     

Laparoscopic versus open appendectomy for complicated appendicitis

BACKGROUND: Laparoscopic appendectomy has been widely practiced for uncomplicated appendicitis; various reports demonstrated its merits in assisting diagnosis, reducing postoperative pain, analgesic requirement, and incidence of wound infection. The role of laparoscopy in management of complicated appendicitis, ie, gangrenous, perforated appendicitis and appendiceal abscess, remains undefined. Currently, the choice of operative approach is mostly at the surgeons' discretion. A retrospective study was conducted in our institution to review the feasibility, safety, and efficacy of laparoscopic appendectomy for patients with complicated appendicitis. STUDY DESIGN: From January 1999 to January 2004, records of patients older than 14 years of age with diagnosis of appendicitis were retrieved from computer database for analysis. All patients underwent diagnostic laparoscopy to confirm diagnosis of complicated appendicitis, and patients subsequently underwent either laparoscopic or open appendectomies. Patients' demographics data and perioperative outcomes from the two groups were compared. RESULTS: During the study period, 1,133 patients with acute appendicitis underwent operations in our institution. Two hundred forty-four patients (21.5%) with complicated appendicitis were identified by laparoscopy, of which 175 underwent laparoscopic appendectomy (LA) and 69 had open appendectomy (OA). Both groups of patients were comparable in demographics. Mean operative time was 55 minutes for LA group and 70 minutes for the OA group (p<0.001). Mean hospital stay was 5 days and 6 days for LA and OA group respectively (p<0.001). There was one conversion patient (0.6%) in the LA group who suffered from wound infection, and there were seven (10%) wound infections in the OA group (p=0.001). There were 10 cases (5.7%) of intraabdominal collection in the LA group and 3 (4.3%) in the OA group (p=0.473). There was no mortality in the current series. CONCLUSIONS: Laparoscopic appendectomy for complicated appendicitis is feasible and safe. It is associated with a significantly shorter operative time, lower incidence of wound infection, and reduced length of hospital stay when compared with patients who had open appendectomy.     

小儿腹腔镜阑尾切除与开腹阑尾切除的临床对比研究

【摘要】 目的 对比研究小儿腹腔镜阑尾切除术(LA)与传统开腹阑尾切除术(OA)的临床疗效及安全性。方法 回顾性分析2009年1月~2012年12月期间进行LA和OA的93例小儿阑尾炎患者的临床资料,对两组手术时间、术中出血情况、术后恢复情况等进行统计对比分析。结果〓两组患儿手术及恢复顺利,术后无严重并发症。两组手术时间及术中出血量差异均无统计学意义(P>0.05);LA组术后肛门排气时间、下床活动时间、切口疼痛时间、术后住院天数均低于OA组,差异有统计学意义(P<0.05)。结论 与OA比较,小儿LA具有创伤小、并发症少,恢复快及美容等优势,是治疗小儿阑尾炎理想的手术方式。     

开腹和腹腔镜阑尾切除术治疗妊娠期急性阑尾炎的对照研究

目的 比较开腹阑尾切除术（open appendectomy,OA）和腹腔镜阑尾切除术（laparoscopic appendectomy,LA）治疗妊娠期急性阑尾炎的安全性及疗效.方法 回顾性分析我院2008年1月至2013年1月收治的68例妊娠早、中期急性阑尾炎的临床资料,其中OA组36例,LA组32例,并进行比对分析.结果 两组病例手术均顺利完成,OA组和LA组在妊娠相关并发症发生率上无明显差异（P＞0.05）;而在术后肛门排气时间、住院时间及术后并发症上,LA组均明显优于OA组,差异有统计学意义（P＜0.05）.结论 LA治疗妊娠早、中期急性阑尾炎是安全可行的,具有创伤小、术后恢复快、并发症少等优点.     

腔镜阑尾切除术与开腹阑尾切除术的临床对比研究

目的 比较腹腔镜阑尾切除术与开腹阑尾切除术的临床治疗效果。方法 采用我院2008年1月至2011年6月间腹腔镜阑尾切除术的患者62例与传统开腹阑尾切除术102例做对比,比较两者在手术时间、术后胃肠功能恢复时间、住院时间和术后并发症等方面的发生率有无显著性差异。结果 两者在术后胃肠功能恢复时间、住院时间和术后并发症发生率上有显著性差异。结论 腹腔镜阑尾切除术相对于开腹阑尾切除术,术后胃肠功能恢复时间快,住院时间短,术后并发症少。     

Laparoscopic appendectomy versus open appendectomy in children: another opinion

Laparoscopic appendectomy (LA) is a commonly performed procedure that is a safe alternative to conventional open appendectomy (OA). LA offers reduced parietal scarring, a shortened hospital stay, and an earlier return to normal activities. During a 13-month period (July 2001 to July 2002), data were collected regarding appendectomies performed in 113 children (<18 years) in our hospital. Patients were divided into two groups according to type of appendectomy received (OA, N = 59 versus LA, N = 54). The operative time, length of hospital stay, and postoperative complications were compared between the two groups. Operative time was similar in the OA and LA groups (1.20 +/- 0.46 versus 1.12 +/- 0.36 hours, respectively; P = 0.328). Patients receiving OA had significantly longer hospital stays than those receiving LA (4.69 +/- 3.45 versus 3.07 +/- 1.93 days, respectively; P = 0.002). The complication rate associated with OA was higher than that observed for LA (6.8% versus 3.5%), but this difference was not significant (P = 0.681). Patients receiving LA could begin drinking water earlier after surgery than postflatus OA patients (12-24 hours versus 3.2 days). The OA group had a higher rate of ruptured appendicitis than the LA group (13/59 versus 2/54), but similar rates of normal appendix was observed in both groups (13/59 versus 13/54). Three patients in the LA group were switched to OA. Although patients who underwent LA did not experience a significant decrease in complications compared with OA patients, they did have shorter hospital stays and postoperative NPO times. Therefore, LA seems to be a safe operation in children. It is ideal for overweight, adolescent females and patients in whom appendicitis is suspected. LA is not recommended for those with an appendiceal mass.     

腹腔镜复杂性阑尾切除术的体会

目的:探讨腹腔镜在复杂性阑尾切除术中的应用价值。方法:回顾分析1999～2009年施行907例复杂性阑尾切除术的临床资料,其中482例行腹腔镜阑尾切除术(laparoscopic appendectomy,LA),425例行传统开腹阑尾切除术(open ap-pendectomy,OA),对比分析两组手术情况及手术效果。结果:OA组在手术时间、住院费用方面优于LA组,但差异无统计学意义(P>0.05);在肛门恢复排气时间、住院时间、术后切口感染率、术后腹腔内残余脓肿发生率及术后粘连性肠梗阻发生率方面LA组优于OA组,差异有统计学意义(P<0.05);LA组术后肠梗阻形成时间优于OA组,但差异无统计学意义(P>0.05)。结论:与传统开腹阑尾切除术相比,LA在复杂性阑尾切除术中具有明显优势,具有术后肛门排气快、住院时间短、术后感染性并发症发生率低等优点,且并不明显增加住院费用及手术时间,可作为处理复杂阑尾炎时的首选术式。     

腹腔镜与开腹阑尾切除术的临床比较

目的:比较腹腔镜与开腹手术切除阑尾的优缺点。方法:回顾性分析我院2010年1月1日—2012年3月31日292例行阑尾切除术患者的临床资料,根据手术方法分为单孔法腹腔镜阑尾手术组、多孔法腹腔镜阑尾手术组和开腹阑尾手术组,比较手术时间、出血量、术后排气时间、术后住院时间切口愈合等级及感染率。结果:单孔法腹腔镜阑尾手术组中1例转为多孔法,多孔法腹腔镜阑尾手术组中1例中转开腹,其余患者均完成手术。2例多孔法腹腔镜阑尾手术患者术后并发粘连性肠梗阻,经保守治疗后好转。与传统开腹手术相比,腹腔镜阑尾切除术手术时间短、出血量少、术后排气快、术后住院时间短;对于急性单纯性阑尾炎,单孔腹腔镜手术比多孔法出血更少,瘢痕更小。结论:腹腔镜阑尾切除术对腹部干扰少,单孔法切口更为隐蔽,在熟练掌握手术技术的前提下可以广泛应用。     

腹腔镜阑尾切除术与传统手术疗效的比较

目的:比较腹腔镜阑尾切除术(laparoscopic appendectomy,LA)与传统开腹阑尾切除术(open appendectomy,OA)的临床疗效。方法:随机将223例阑尾炎患者分为两组,LA组115例行LA,OA组108例行OA。比较两种术式的手术时间、平均住院费用、住院时间、术后镇痛剂应用、术后24h内肛门排气例数、放置引流管率、切口感染率等。结果:LA组术后24h内肛门排气时间、放置引流管率、切口感染率、平均住院时间、粘连性肠梗阻、镇痛剂应用例数与OA组的差异有统计学意义(P<0.05);两组手术时间差异无统计学意义(P>0.05);LA组住院费用明显高于OA组(P<0.05)。结论:LA具有手术损伤小,患者疼痛轻、康复快、住院时间短、并发症少等优点,可作为多数阑尾炎患者的首选术式。