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。

Experience of laparoscopic complicated appendectomy

Objective:To discuss the application value of laparoscopic appendectomy(LA) for complicated appendicitis.Methods:The clinical data of nine hundred and seven consecutive patients with complicated appendicitis(perforated/gangrenous/diffuse peritonitis/mass formation) in our hospital from 1999 to 2009 were retrospectively analyzed.This study was comprised of 482 patients who underwent LA and 425 patients treated with open appendectomy(OA).The two groups were compared with respect of operative outcomes.Results:The average operative time was relatively longer and the hospitalization expense was higher in LA group than those in OA group,but both differences were not statistically significant(P>0.05);The mean exhaust time and the mean hospital stay were significantly shorter in LA group compared with OA group(P<0.05).There was significant difference in incision infection rate,intra-abdominal abscess formation rate and adhesive intestinal obstruction(AIO) rate between the two groups(P<0.05).The mean time of the occurrence of AIO after LA was(43±18) days,and it was(47±20) days in the OA group(P>0.05).Conclusions:With regard to complicated appendicitis,LA has its obvious advantages over OA with quicker recovery,shorter hospital stay,and lower postoperative infectious complication rate.Meanwhile,it will not obviously increase the hospitalization expense and operating time.Thus,it is considered as the first choice for complicated appendicitis in general surgery.