腹腔镜阑尾切除术的疗效及对并发症的影响

目的比较腹腔镜阑尾切除术（LA）与开腹阑尾切除术（OA）治疗急阑尾炎的临床疗效及并发症。 方法选择2014年1月至2015年5月收治的拟行阑尾切除术的阑尾炎患者118例，将患者随机分为试验组和对照组，每组59例，试验组采用LA术，对照组采用OA术，比较两组患者的临床效果及并发症发生情况，评价急性和慢性阑尾炎行腹腔镜手术的效果。 结果与对照组比较，试验组的手术时间延长，而住院时间、术后首次下床、排气及进食时间均明显缩短，24 h镇痛药物使用率也显著减少，住院费用明显增加（t=14.342、6.916、4.166、9.527、8.036，χ²=5.950，t=32.663，P<0.05）。试验组中急性阑尾炎患者34例，与25例慢性阑尾炎患者比较，手术时间、住院时间、术后首次排气及进食时间均明显延长，术中出血量明显增加（t=8.195、1.776、5.329、4.337、3.757，P<0.05）。试验组术后24 h、48 h时白细胞（WBC）、C反应蛋白（CRP）水平均显著低于对照组（P<0.05）；伤口感染、腹腔脓肿的发生率及总发生率显著低于对照组（χ²=4.827、4.140、10.602，P<0.05）。 结论LA治疗急性及慢性阑尾炎均安全有效，可减少术后并发症，促进术后恢复。

Efficacy and complications of laparoscopic appendectomy

ObjectiveTo compare the efficacy and complications between laparoscopic appendectomy (LA) and open appendectomy (OA). MethodsOne hundred and eighteen appendicitis patients undergoing appendectomy were chosen from January 2014 to May 2015. All the cases were divided into the trial group (59 cases, received LA) and the control group (59 cases, received OA). The clinical efficacy and complications of two groups and the outcome of LA for acute and chronic appendicitis were compared. ResultsCompared with control group, the operation time increased in the trial group, while hospital stay, postoperative first bed-off time, passing flatus, and first food-taking shortened; usage of anesthetics within 24 h reduced, and hospitalization expenses increased (t=14.342, 6.916, 4.166, 9.527, 8.036, χ²=5.950, t=32.663, P<0.05). In the trial group, compared with 25 cases with chronic appendicitis, the other 34 cases with acute appendicitis had longer operation time, hospital stay, time of postoperative first passing flatus and first food-taking, more intraoperative blood loss (t=8.195, 1.776, 5.329, 4.337, 3.757, P<0.05). The levels of WBC, CRP at 24 h, 48 h after operation in the trial group were significantly lower than those in control group (P<0.05). The incidence of wound infection, celiac abscess and total incidence in experimental group were significantly lower than those in control group (χ²=4.827, 4.140, 10.602, P<0.05). ConclusionLA is safe and effective in the treatment of acute and chronic appendicitis, which can reduce the postoperative complications and promote postoperative recovery.