小儿复杂性阑尾炎的腹腔镜治疗

目的 对比分析腹腔镜阑尾切除术(laparoscopic appendectomy,LA)和开腹阑尾切除术( open appendectomy,OA)治疗伴有坏疽、穿孔及阑尾周围脓肿的儿童阑尾炎的疗效.方法 回顾性分析614例儿童复杂性阑尾炎患者的临床资料,比较LA组(267例)和OA组(347例)手术时间、住院时间、住院费用及术后并发症的发生率.结果 本组614例患者中无手术死亡发生,LA组有7例中转开腹手术,LA组术后住院时间较OA组短(4.6d比8.1d,P=0.00),Trocar孔或切口感染(5.3％比12.8％,P=0.03)、肠梗阻(5.0％比10.0％,P=0.04)及院内感染发生率(9.7％比18.3％,P=0.04)均较OA组低.术后LA组腹腔脓肿发生率较OA组高(4.1％比1.1％,P=0.04),差异有统计学意义.两组的手术时间及费用之间比较差异无统计学意义(均P＞0.05).结论 LA具有创伤小、恢复快、并发症少、住院时间短等优点,是治疗儿童复杂性阑尾炎一种安全有效的手术方式,但术后腹腔脓肿发生率偏高.     

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.     

Laparoscopic appendectomy for perforated appendicitis: a comparison with open appendectomy

Background The role of laparoscopic appendectomy for perforated appendicitis remains controversial. This study aimed to compare laparoscopic and open appendectomy outcomes for children with perforated appendicitis. Methods Over a 36-month period, 111 children with perforated appendicitis were analyzed in a retrospective review. These children were treated with either laparoscopic (n = 59) or open appendectomy. The primary outcome measures were operative time, length of hospital stay, time to adequate oral intake, wound infection, intraabdominal abscess formation, and bowel obstruction. Results The demographic data, presenting symptoms, preoperative laboratory values, and operative times (laparoscopic group, 61 ± 3 min; open group, 57 ± 3 were similar for the two groups (p = 0.3). The time to adequate oral intake was 104 ± 7 h for the laparoscopic group and 127 ± 12 h for the open group (p = 0.08). The hospitalization time was 189 ± 14 h for the laparoscopic group, as compared with 210 ± 15 h for the open group (p = 0.3). The wound infection rate was 6.8% for the laparoscopic group and 23% for the open group (p < 0.05). The wounds of another 29% of the patients were left open at the time of surgery. The postoperative intraabdominal abscess formation rate was 13.6% for the laparoscopic group and 15.4% for the open group. One patient in each group experienced bowel obstruction. Conclusions Laparoscopic appendectomy for the children with perforated appendicitis in this study was associated with a significant decrease in the rate of wound infection. Furthermore, on the average, the children who underwent laparoscopic appendectomy tolerated enteral feedings and were discharged from the hospital approximately 24 h earlier than those who had open appendectomy.     

腹腔镜与开腹阑尾切除术治疗儿童复杂性阑尾炎的回顾性研究

目的 对比分析腹腔镜阑尾切除术(LA)与开腹阑尾切除术(OA)治疗儿童复杂性阑尾炎,以评价腹腔镜治疗儿童复杂性阑尾炎的效果.方法 回顾分析手术治疗儿童复杂性阑尾炎189例临床资料,其中LA 113例,OA 76例.比较两组手术时间、术中出血量少、恢复进食时间、感染性并发症发生率、术后住院天数、抗生素使用时间及手术费用等指标.结果 LA组比OA组手术时间长,手术费用高,差异有统计学意义,但LA组术中出血量少、术后开始进食时间及住院时间均短于OA组,而且切口感染率及腹腔内脓肿发生率较OA组低(P<0.05).虽然LA组术后抗生素使用时间短于OA组,但差异无统计学意义(P=0.113).结论 LA具有创伤小、恢复快、并发症少等优点,用于治疗儿童复杂性阑尾炎可行,且安全有效.     

儿童阑尾穿孔的腹腔镜阑尾切除术

目的 :探讨儿童阑尾穿孔腹膜炎行腹腔镜阑尾切除术的优缺点。方法 :分析 30例阑尾穿孔并腹膜炎手术治疗患儿的临床资料 ,其中 15例行LA为腹腔镜组 ,15例开腹阑尾切除术为对照组。比较两组病例的手术时间、术后引流时间、住院时间、术后并发切口感染及腹腔残余感染等情况。结果 :15例LA手术时间 30～ 75min ,平均 5 2min ,几乎无出血 ,术中冲洗并吸尽腹腔内脓液后留置腹腔引流 2～ 3d ;切口感染 1例 ,平均住院 7d。对照组 15例手术时间 4 5～ 110min ,平均 6 4min ,腹腔残余感染 3例 ,切口感染 2例 ,肠粘连 1例。结论 :阑尾穿孔并腹膜炎患儿行LA比常规开腹术恢复快 ,住院时间短 ,切口感染及腹腔残余感染发生率明显降低 ,且切口疤痕小 ,美容效果好。阑尾脓肿形成早期不是LA的禁忌证 ,但阑尾脓肿并广泛包裹者不宜行LA。     

腹腔镜在慢性阑尾炎诊治中的应用价值(附296例报告)

目的:比较腹腔镜手术与开腹手术在慢性阑尾炎治疗中的应用价值。方法:回顾分析2000年1月至2008年12月我院施行296例慢性阑尾炎手术的临床资料,164例行开腹手术,132例行腹腔镜手术,对比两组手术时间、术中出血、住院时间、术中发现和处理情况,并随访患者术后慢性腹痛的改善情况。结果:手术时间开腹组(52.76±21.82)m in,腹腔镜组(49.78±18.01)m in,t=0.88,P>0.05;术中出血开腹组(16.60±8.28)m l,腹腔镜组(9.68±4.22)m l,t=3.48,P<0.05;住院时间开腹组(7.84±3.27)d,腹腔镜组(6.80±2.98)d,t=2.98,P<0.05。腹腔镜组30例(22.7%)术中发现不同程度的腹腔粘连,阑尾与周围粘连10例,回盲部与前侧腹壁粘连8例,大网膜与腹壁及肠管粘连6例,升结肠与周围及腹腔内其他粘连6例,均在术中给予松解;开腹组18例(11.0%)术中发现阑尾与周围粘连,松解粘连行阑尾切除术,两组比较χ2=8.06,P<0.05;成功随访122例开腹手术者术后26例(21.3%)仍有慢性腹痛,98例腹腔镜手术者术后10例(10.2%)仍有慢性腹痛,两组比较χ2=6.68,P<0.05。结论:腹腔镜对慢性阑尾炎的诊治有一定的优势。     

慢性阑尾炎腹腔镜与开腹手术疗效比较

目的比较腹腔镜手术与开腹手术对治疗慢性阑尾炎的I临床疗效。方法将2000年1月至2005年6月间收治的224例慢性阑尾炎患者按其个人意愿分为腹腔镜手术组（98例）与开腹手术组（126例），对比两组在手术时间、术中出血、住院时间、术中发现和处理的差异，并随访患者术后慢性腹痛的改善情况。结果开腹组手术时间（54．8±21．8）min，腹腔镜组则为（51．8±18．0）min（t=0.80，P〉0．05）；开腹组术中出血（18．6±23．3）ml，腹腔镜组则为（9．8±4．7）ml（t=3．13，P〈0．05）；开腹组住院时间（8．9±5．3）d，腹腔镜组则为（6．8±3．0）d（t=2．66，P〈0．05）。腹腔镜手术组发现有不同程度的腹腔粘连25例（25．5％），其中阑尾与周围粘连9例，回盲部与前侧腹壁粘连6例，大网膜与腹壁及肠管粘连4例，升结肠与周围及腹腔内其他粘连6例，均在术中给予松解：开腹手术组发现阑尾与周围粘连14例（11．1％），松解粘连行阑尾切除术（x^2=7．95，P〈0．05）。术后开腹手术组慢性腹痛发生率24．5％（24／98例），而腹腔镜手术组仅占10．3％（9／87例），两组比较x^2=6．29，P〈0．05；差异有统计学意义。结论腹腔镜手术对慢性阑尾炎的治疗同样具有一定优势，且能降低术后慢性腹痛的发生率。     

Laparoscopic versus open appendectomy for perforated appendicitis

The role of laparoscopic appendectomy (LA) for perforated appendicitis is under investigation. A retrospective study was conducted to compare the outcomes of laparoscopic versus open appendectomy (OA) for perforated appendicitis. From January 2001 through December 2003, 229 patients with perforated appendicitis were treated at Far-Eastern Memorial Hospital. LA was successfully completed in 91 of 99 patients. OA was performed in 130 patients. Operation time was longer in the LA group (mean ± SD =96.1±43.1 vs. 67.8±32.2 minutes, P<0.01). Return of oral intake was faster in the LA group (3.2±2.4 vs. 5.0±7.0 days, P<0.01). The intravenous antibiotic usage period was shorter in the LA group (4.4±2.8 vs. 6.3±7.1 days, P<0.01). The postoperative wound infection rates were 15.2 % (LA group) and 30.7% (OA group). The overall infectious complication rates were 19% in the LA group and 37% in the OA group (P<0.01). Hospital stay days were shorter for the LA group (6.3±2.9 vs. 9.3±8.6 days, P<0.01). Our results indicated that laparoscopic appendectomy is a safe and effective procedure for treating patients with perforated appendicitis.     

腹腔镜阑尾切除术在急性和慢性阑尾炎中应用疗效的比较

目的 通过探讨腹腔镜阑尾切除术在治疗急性和慢性阑尾炎中疗效的优缺点,总结腹腔镜阑尾切除术的手术经验.方法 连续收集北京大学人民医院自2008年6月至2009年12月129例阑尾炎患者的资料,比较急性阑尾炎患者腹腔镜与开腹手术的临床效果,以及急性与慢性阑尾炎的腹腔镜治疗效果.结果 对于急性阑尾炎患者,接受腹腔镜手术患者术后住院时间明显少于开腹组[(4.8±2.6)d比(7.0±1.3)d,t=0.679,P=0.006].在接受腹腔镜组阑尾切除术的患者中,急性阑尾炎患者的平均手术时间[(77±33) min比(55±23) min,t=3.431,P＜0.01]、术后首次排气时间[(2.3±1.2)d比(1.4±0.9)d,t=4.665,P＜0.01]、术后首次进食时间[(2.3±1.4)d比(1.2±0.6)d,t=4.517,P＜0.01)]均长于慢性阑尾炎患者.结论 腹腔镜阑尾切除术治疗急性阑尾炎安全可行;与慢性阑尾炎患者相比,急性阑尾炎患者行腹腔镜阑尾切除术可能导致更多的术后腹腔脓肿和小肠梗阻等并发症.     

腹腔镜与开腹手术治疗小儿急性阑尾炎的比较

目的对比分析腹腔镜和开腹阑尾切除术在治疗小儿急性阑尾炎中的效果。方法2000年7月~2005年7月,对95例小儿急性阑尾炎实施手术,其中腹腔镜阑尾切除术(laparoscop ic appendectomy,LA)50例,开腹阑尾切除术(openappendectomy,OA)45例,比较2组手术情况和疗效。结果2组手术均成功,无出血、肠瘘和残株炎等并发症。LA组手术时间(38.8±17.4)m in,OA组(41.9±15.8)m in,2组差异无显著性(t=-0.905,P=0.368)。LA组排便时间(26.4±7.2)h,显著短于OA组的(39.7±8.8)h(t=-8.094,P=0.000)。LA组阑尾根部穿孔29例,OA组26例,2组无统计学差异(2χ=1.633,P=0.983)。OA组切口并发症发生率(11/45)显著高于LA组(2/50)(2χ=8.381,P=0.004)。OA组放引流管率(9/45)显著高于LA组(3/50)(2χ=4.206,P=0.040)。LA组体温恢复正常时间(55.4±16.2)h显著短于OA组的(77.8±30.6)h(t=-4.522,P=0.000)。LA组住院时间(5.4±1.3)d显著短于OA组的(13.4±6.5)d(t=-8.520,P=0.000)。LA组住院费用(6 117.9±836.5)元显著高于OA组的(4 528.6±527.1)元(t=10.937,P=0.000)。结论腹腔镜阑尾切除术较开腹手术具有创伤小、恢复快、腹壁瘢痕轻、并发症少和住院时间短等优点,是治疗小儿急性阑尾炎较为理想的方法。     

腹腔镜与开放手术治疗急性阑尾炎的疗效比较

目的 对比分析腹腔镜和开腹手术治疗急性阑尾炎的手术效果和优缺点.方法 将1558例急性阑尾炎患者分为腹腔镜组(779例)和开放组(779例),比较两组手术的临床指标及术后随访情况.采用SPSS11.5软件,计量资料采用t检验,计数资料采用X~2检验.结果 两组手术均顺利完成.腹腔镜组和开放组手术时间分别为(30±2.2)min和(30±1.6)min(t=0.00,P>0.05);术中出血量分别为(15±2.9)ml及(29±5.2)ml(t=65.62,P<0.05);术后下床活动时间分别为(26±3.1)h及(51±2.1)h(t=69.95,P<0.05);术后排气时间分别为(29±1.6)h及(52±4.6)h(t=10.92,P<0.05);住院时间分别为(3±0.9)d及(7±1.2)d(t=74.42,P<0.05);综合费用分别为(6591±41)元及(4860±32)元(t=-12.19,P<0.05);切口感染率分别为0及2.8%(X~2=25.40,P<0.05);止痛药使用频率分别为3.8%和31.4%(X~2=30.63,P<0.05).随访时间为4.5～9.8(平均6.8)年,切口疝的发生率分别为0及0.64%(X~2=5.01,P<0.05).结论 腹腔镜手术治疗急性阑尾炎具有创伤小、恢复快、并发症少和平均住院时间短等优点,是治疗急性阑尾炎较为理想的手术方式.     

腹腔镜阑尾切除与开腹阑尾切除术的对比研究及Meta分析

目的比较腹腔镜与开腹阑尾切除术对急性阑尾炎的疗效和手术安全性。方法收集2006年10月至2007年10月问120例急性阑尾炎患者进行前瞻性研究,随机分为两组,分别采用腹腔镜阑尾切除（LA）术式和开腹阑尾切除（OA）术式,对手术时间、术中出血量、术后胃肠功能恢复时间、止痛药物应用时间、开始进食时间、住院天数和术后并发症等指标进行比较分析。并对1996年1月至2008年12月期间的该类前瞻性随机对照研究（RCT）文献进行Meta分析,比较两种术式手术时间、住院天数和并发症等指标。结果本组资料表明,两组手术时间、出血量无明显差异,而LA组肠功能恢复时间、止痛药物应用时间、住院天数明显短于OA组,LA组手术并发症也少于OA组;Meta分析有6组资料纳入,LA住院天数和手术并发症少于OA组,而两组的手术时间无明显差异。结论腹腔镜阑尾切除术具有恢复时间短、术后疼痛轻、住院时间短和并发症发生率低等优点,值得推荐。     

根部坏疽穿孔性阑尾炎的腹腔镜治疗

目的:探讨腹腔镜阑尾切除术(LA)治疗根部坏疽穿孔性阑尾炎的安全性和可行性。方法:总结2001年9月至2004年9月应用LA治疗45例根部坏疽穿孔性阑尾炎的临床资料,术中处理阑尾根部时,Endoloop阑尾根部直接套扎23例,间断缝合阑尾残端加医用生物蛋白胶覆盖15例,清除阑尾残余组织加医用生物蛋白胶覆盖残端放置硅胶引流管7例。结果:手术全部成功,无中转开腹,平均手术时间76.3m in,术后排气时间23.8h,11例术后使用止痛药,1例戳口感染,无肠漏及腹腔脓肿发生,平均住院时间5.5d。结论:对于根部坏疽穿孔性阑尾LA术是可行的,并具有创伤小、康复快、并发症少等优点。     

坏疽、化脓性阑尾炎合并穿孔的腹腔镜治疗

目的:探讨腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗坏疽、化脓性阑尾炎合并穿孔的安全性和可行性。方法:总结2002年1月至2007年12月应用LA治疗93例坏疽、化脓性阑尾炎合并穿孔患者的临床资料,术中处理阑尾根部时,使用Endo-loop阑尾根部双重套扎或双重钛夹夹闭46例,直接腹腔镜下丝线打结阑尾根部23例,间断缝合阑尾残端加医用生物蛋白胶覆盖15例,清除阑尾残余组织加医用生物蛋白胶覆盖残端,放置硅胶引流管9例。结果:93例手术均获成功,无中转开腹,平均手术时间72min,术后排气时间22.5h,11例术后使用止痛药或止痛针,1例戳口感染,无肠漏及腹腔脓肿发生,平均住院5d。结论:随着腹腔镜技术的不断成熟、完善,对于坏疽、化脓性阑尾炎合并穿孔患者行LA是安全可行的,具有患者创伤小、痛苦轻、疤痕小、康复快、并发症少等优点。     

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.     

腹腔镜与开腹阑尾切除术治疗急性阑尾炎的疗效分析

目的 比较腹腔镜阑尾切除术(laparoscopic appendectomy,LA)和开腹阑尾切除术(open appendectomy,OA)治疗急性阑尾炎的结果.方法 将2005年5月至2010年5月收治的396例行阑尾切除术的急性阑尾炎病人按手术方法分为LA组和OA组,比较分析两组病人的临床资料.结果 LA组与...     

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.     

Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis

Background  

Currently, laparoscopic appendectomy (LA) provides a safe and effective alternative to open appendectomy (OA), but its use remains controversial. This study aimed to evaluate the efficiency and safety of LA through a metaanalysis.     

Laparoscopic appendectomy for complicated acute appendicitis

The role of laparoscopic appendectomy in complicated appendicitis is still not widely accepted. The authors report their retrospective study performed to evaluate the effectiveness of the laparoscopic approach in the management of complicated appendicitis. From January 2003 to October 2008, 552 patients underwent appendectomy in our surgical department. Among these, 358 were not complicated appendicitis while 194 were complicated. Of the 194 cases of complicated appendicitis, 121 patients underwent laparoscopic appendectomy while the remaining 73 cases were treated by conventional open surgery. The average length of hospital stay was 5.7 days, with a range from 4 to 13 days. Post-operative complications were observed in a total 11 patients (9.1%), including 3 cases of intra abdominal abscess (2.5%), 2 cases of umbilical wound infection (1.6%) and 6 cases of prolonged ileus (4.9%). Our experience suggests that the laparoscopic procedure is a valid, safe and feasible option to manage acute complicated appendicitis.