开腹与腹腔镜阑尾切除术治疗急性阑尾炎的疗效对比

目的:探讨开腹阑尾切除术(open appendectomy,OA)与腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗急性阑尾炎的临床疗效。方法:选择2009年2月至2012年11月收治的197例急性阑尾炎患儿,其中91例行LA(观察组),106例行OA(对照组),对比分析两组患儿手术时间、术后肛门排气时间、住院时间、切口感染、腹腔脓肿及肠梗阻情况。结果:观察组单纯性阑尾炎及化脓性阑尾炎患儿术后肛门排气时间、住院时间均明显短于对照组(P<0.05),但手术时间明显长于对照组(P<0.05)。观察组坏疽穿孔阑尾炎患儿术后肛门排气时间明显短于对照组(P<0.05),手术时间长于对照组(P<0.05),观察组切口感染、腹腔脓肿及肠梗阻发生率明显低于对照组(P<0.05)。结论:单纯性与化脓性阑尾炎患儿行LA可明显缩短住院时间与肛门排气时间;对于坏疽穿孔性阑尾炎患儿,LA可明显缩短肛门排气时间,降低切口感染、腹腔脓肿发生率。临床应合理选择术式。

Comparative study on the efficacy of open and laparoscopic appendectomy for acute appendicitis

Objective： To study the clinical efficacy of open and laparoscopic appendectomy for acute appendicitis.Methods： The clinical data of 197 children who underwent open（106 cases） or laparoscopic（91 cases） appendectomy for acute appendicitis from Feb.2009 to Nov.2012 were analyzed retrospectively.The operation duration,postoperative exhausting time,hospital stay,incision infection,peritoneal abscess and intestinal obstruction were comparatively analyzed.Results： Of the patients who suffered from simple or suppurative appendicitis,the operative time of the laparoscopic group was longer（P 0.05）,the exhausting time and hospital stay were shorter than those of open group（P 0.05）.Of the patients who suffered from gangrenous perforative appendicitis,the exhausting time of laparoscopic group was shorter than that of open group（P 0.05）,the operation duration was longer than that of open group（P 0.05）,the incision infection,peritoneal abscess and intestinal obstruction incidence of laparoscopic group were less than those of open group（P 0.05）.Conclusions： Laparoscopic appendectomy can obviously shorten the hospital stay and exhausting time of children who suffer from simple or suppurative appendicitis,while for the children who suffer from gangrenous perforative appendicitis,laparoscopic appendectomy can not only shorten the exhausting time but also reduce the incidence of incision infection and peritoneal abscess.It is important to choose the appropriate technique clinically.