Eypasch Ernst, Sauerland Stefan, Lefering Rolf, Neugebauer Edmund A M
Chirurgische Klinik, Malteserkrankenhaus St.Hildegardis Köln-Lindenthal, Bachemer Strasse 29-31, D-50931 Cologne, Germany.
Dig Surg. 2002;19(6):518-22. doi: 10.1159/000067608.
Laparoscopic surgery has been proposed to have diagnostic and therapeutic advantages over conventional surgery. The purpose of this article is to present a recently completed Cochrane review on laparoscopic surgery for suspected appendicitis on the background of daily surgical practice and the developments in the last decade.
Within the Cochrane review, various medical databases (Medline, Embase, Cochrane, SciSearch) were searched electronically until October 2001. Congress proceedings were searched by hand. Randomized controlled trials were included that assessed the therapeutic effects of laparoscopic appendectomy (LA) versus open appendectomy (OA) in adults and children, the diagnostic effects of laparoscopy followed by LA or OA if necessary versus immediate OA, and the therapeutic effects of diagnostic laparoscopy followed by OA if necessary versus immediate OA.
Based on 45 studies, wound infection was half as likely while intra-abdominal abscesses were three times more frequent after LA. Return to normal activity showed a uniform tendency in favor of LA. Pain was also reduced, but data vary and most primary studies were not blinded. Obvious diagnostic advantages concerned the negative appendectomy rate and the rate of patients without established diagnosis, both being reduced to 0.2-0.3 (RR).
The review finds that laparoscopic surgery for suspected appendicitis has diagnostic and therapeutic advantages as compared to conventional surgery--a fact which is in full agreement with the daily practice of surgeons interested in endoscopic surgery.
有人提出腹腔镜手术相较于传统手术具有诊断和治疗优势。本文旨在结合日常外科实践背景以及过去十年的发展情况，呈现一篇近期完成的关于腹腔镜手术治疗疑似阑尾炎的Cochrane系统评价。
在该Cochrane系统评价中，通过电子检索各种医学数据库（Medline、Embase、Cochrane、SciSearch）直至2001年10月。同时手工检索会议论文集。纳入的随机对照试验评估了成人和儿童腹腔镜阑尾切除术（LA）与开腹阑尾切除术（OA）的治疗效果、腹腔镜检查后必要时行LA或OA与直接行OA的诊断效果，以及诊断性腹腔镜检查后必要时行OA与直接行OA的治疗效果。
基于45项研究，LA术后伤口感染的可能性减半，而腹腔内脓肿的发生率则高出三倍。恢复正常活动呈现出一致的倾向，有利于LA。疼痛也有所减轻，但数据存在差异，且大多数原始研究未设盲。明显的诊断优势在于阴性阑尾切除率和未确诊患者的比例，两者均降至0.2 - 0.3（相对危险度）。
该系统评价发现，与传统手术相比，腹腔镜手术治疗疑似阑尾炎具有诊断和治疗优势——这一事实与对内窥镜手术感兴趣的外科医生的日常实践完全一致。
