Alvarez C, Voitk A J
Department of Surgery, Salvation Army Scarborough Grace Hospital, Ontario, Canada.
Am J Surg. 2000 Jan;179(1):63-6. doi: 10.1016/s0002-9610(99)00270-6.
This study examines the contribution of increased laparoscopic skills to ambulatory management of perforated appendicitis.
All 38 perforated appendicitides from 151 laparoscopic appendectomies done by one surgeon were studied and ambulatory management (discharge less than 24 hours after surgery) of the last 18 perforations reported.
Over 4 years, rate of attempted laparoscopic appendectomy rose from 67% to 100% for perforations. Conversion rate fell from 100% to 22%. Ileus and pain control were not problems for most laparoscopic perforations, so by the end of 1997, experience suggested these patients might be discharged within 24 hours. Ambulatory rate was 57% (conversions excluded). There were no readmissions for wound infections or postoperative abdominal abscesses.
Increasing laparoscopic skills allows laparoscopic treatment of complicated appendicitis with a low conversion rate and no infectious complications. Over one half of these patients can be managed as outpatients without jeopardy to outcome.
本研究探讨腹腔镜技术提高对穿孔性阑尾炎门诊治疗的作用。
对一位外科医生施行的151例腹腔镜阑尾切除术中的38例穿孔性阑尾炎进行研究，并报告了最后18例穿孔的门诊治疗情况（术后24小时内出院）。
在4年多的时间里，穿孔性阑尾炎的腹腔镜阑尾切除术尝试率从67%上升到100%。中转开腹率从100%降至22%。对于大多数腹腔镜下穿孔病例，肠梗阻和疼痛控制不是问题，因此到1997年底，经验表明这些患者可在24小时内出院。排除中转开腹病例后的门诊治疗率为57%。没有因伤口感染或术后腹腔脓肿而再入院的情况。
腹腔镜技术的提高使复杂阑尾炎的腹腔镜治疗具有低中转开腹率且无感染并发症。超过一半的这类患者可作为门诊患者处理而不影响治疗效果。
