腹腔镜阑尾切除术与开腹阑尾切除术的对比研究

 目的 比较腹腔镜阑尾切除术(laparoscopic appendectomy, LA)与开腹阑尾切除术(open appendectomy, OA)治疗阑尾炎的疗效和安全性。方法 回顾性分析复旦大学附属金山医院2013年1月至2016年10月收治行阑尾切除术患者862例,其中LA组335例,OA组527例。对比分析两组手术时间、出血量、住院时间、住院费用、切口感染、肠梗阻、腹腔脓肿等情况。结果 LA组患者中,325例在腹腔镜下切除阑尾,中转开腹10例(3.0%)。LA组较OA组出血量少［(16.6±13.2) mL vs. (24.7±18.3) mL,P<0.001］,切口感染率低(0.9% vs. 4.9%,P<0.001),术后中-重度疼痛发生率低(4.5% vs.11.6%,P<0.001),平均住院时间短［(4.4±1.9) 天 vs. (5.1±2.5) 天,P<0.001］,住院综合费用高［ (7 806±1 406)元 vs.(4 871±1 308)元,P<0.001］,手术时间长［(41.4±8.1) min vs.(38.8±11.7) min,P<0.001］。两组腹腔脓肿、肠梗阻及再次手术发生率差异无统计学意义。 LA组患者并发症总发生率9.55%,低于OA组的14.42% (P=0.035)。对于超重或肥胖患者(BMI≥24),LA组较OA组有明显微创优势,而且手术时间缩短［(45.2±7.7) min vs.(49.0±7.6)min,P=0.004］,住院费用不增加［(7 951±1 485)元vs.(7 717±1 705)元,P=0.396)］。结论 LA与OA同样安全可靠,在减少切口感染、术后疼痛等并发症方面较OA有明显优势,但费用较高,手术时间稍长。对于超重或肥胖患者LA可作为阑尾切除手术首选。

Clinical comparative study of laparoscopy versus open surgery for appendicitis

Objective To compare and evaluate the effect of laparoscopic and traditional open surgery in the treatment of appendicitis. Methods From Jan. 2013 to Oct. 2016, the clinical data of 862 cases with acute appendicitis from Jinshan Hospital, Fudan University were analyzed retrospectively. Among them, 335 cases were treated with laparoscopic appendectomy (LA) and 527 cases with open appendectomy (OA). The time of operation, bleeding volume, the postoperative hospital stay, hospitalization costs, incision infection, intestinal obstruction and intra-abdominal abscess were compared between the two groups. Results In LA group,325 cases had successful LA, and 10 cases turned to OA (3.0%). Compared with OA, LA was associated with reduced risk of surgical-site infection (0.9% vs. 4.9%, P<0.001), less bleeding volume ［(16.6±13.2) mL vs. (24.7±18.3) mL, P<0.001］, shorter hospital stay ［(4.4±1.9) d vs. (5.1±2.5) d, P<0.001］, less postoperative pain (4.5% vs. 11.6%, P<0.001). The time of operation and hospitalization costs in the LA group ［(41.4±8.1) min, (7 806±1 406) yuan］ were longer and higher than that in the OA group ［(38.8±11.7) min, (4 871±1 308) yuan］, respectively (P all<0.001). There was no significant difference in intra-abdominal abscesses, intestinal obstruction and reoperation rate between the two groups. The total incidence of complications in LA group ［9.55% (32/335)］ was lower than that in OA group ［14.42% (76/527),P=0.035］. LA had the advantages of minimal invasion, shorten operation time［(45.2±7.7) min vs. (49.0±7.6) min, P=0.004］,without increasing the cost ［(7 951±1 485) yuan vs.(7 717±1 705) yuan, P=0.396］, which was a more popular choice for overweight or obesity (BMI≥24) patients. Conclusions LA is a safe and reliable operational way compared with OA. It has obvious advantages in reducing the complications such as incision infection, postoperative pain and so on. While it is not completely accepted because of its higher costs and longer time of operation for the hospital. LA seems to be favored especially in patients with BMI≥24.