腹腔镜、开放及中转开腹阑尾切除术治疗穿孔性阑尾炎的比较

Comparison of laparoscopic, open, and converted appendectomy for perforated appendicitis.

作者信息

Piskun G, Kozik D, Rajpal S, Shaftan G, Fogler R

机构信息

Department of Surgical Services, Brookdale University Hospital and Medical Center, Brooklyn, NY 11229, USA.

出版信息

Surg Endosc. 2001 Jul;15(7):660-2. doi: 10.1007/s004640020072. Epub 2001 May 14.

DOI:10.1007/s004640020072

PMID:11591963

Abstract

BACKGROUND

Perforated appendicitis is associated with a significant risk of postoperative abdominal and wound infection. Only a few controversial studies evaluate the role of laparoscopy in perforated appendicitis. The significance of conversion from laparoscopy to open appendectomy for perforated appendicitis is not well defined. Statistical analysis was performed using Student's t-test.

METHODS

Data on 52 patients with perforated appendicitis were prospectively collected and retrospectively reviewed. Among these patients, 18 had laparoscopic appendectomies (LA); 24 had open appendectomies (OA); and 10 had converted appendectomies (CA). The indications for either method were based on the attending surgeons's philosophy. Laparoscopic appendectomy was performed using a retrograde stapler technique. Operative time, hospital stay, ability to tolerate a liquid diet, and postoperative infectious complications were documented.

RESULTS

No statistically significant difference in the operative time in minutes was found between the LA (114 +/- 29.3), CA (120.0 +/- 32.2), and OA (105.8 +/- 64.1) groups (p = NS). There was no statistically significance difference in length of stay (days) between the LA (9.2 +/- 4.1), OA (10.5 +/- 3.3), and CA (10.0 +/- 1.8) groups. The wound infection rate was less frequent in the LA group (0%) than in 0A (14%) and CA (10%) groups. The rate of intra-abdominal abscess infections (IAAs) and ileus were 22% and 28%, respectively, in LA group, 38% and 29%, respectively, in OA group, and 60% and 50%, respectively, in CA group.

CONCLUSIONS

No difference in the rate of postoperative intra-abdominal abscesses exists between laparoscopic and open appendectomy for perforated appendicitis. Wound infections and ileus complicate the postoperative course of patients after laparoscopic appendectomy less frequently than after open appendectomy. The conversion of laparoscopic to open appendectomy for perforated appendicitis is associated with increased postoperative morbidity.

摘要

背景

穿孔性阑尾炎术后发生腹部和伤口感染的风险很高。仅有少数存在争议的研究评估了腹腔镜检查在穿孔性阑尾炎中的作用。对于穿孔性阑尾炎，由腹腔镜手术转为开腹阑尾切除术的意义尚不明确。采用学生t检验进行统计分析。

方法

前瞻性收集并回顾性分析52例穿孔性阑尾炎患者的数据。这些患者中，18例行腹腔镜阑尾切除术（LA）；24例行开腹阑尾切除术（OA）；10例行中转阑尾切除术（CA）。两种手术方式的适应证均基于主刀医生的理念。腹腔镜阑尾切除术采用逆行吻合器技术。记录手术时间、住院时间、耐受流食能力及术后感染并发症情况。

结果

LA组（114±29.3）、CA组（120.0±32.2）和OA组（105.8±64.1）的手术时间（分钟）无统计学显著差异（p=无统计学意义）。LA组（9.2±4.1）、OA组（10.5±3.3）和CA组（10.0±1.8）的住院时间（天）无统计学显著差异。LA组的伤口感染率（0%）低于OA组（14%）和CA组（10%）。LA组的腹腔内脓肿感染（IAA）率和肠梗阻发生率分别为22%和28%，OA组分别为38%和29%，CA组分别为60%和50%。