Ball C G, Kortbeek J B, Kirkpatrick A W, Mitchell P
Department of Surgery, Foothills Medical Centre, University of Calgary, 1403-29 Street NW, T2 N 2T9, Calgary, Alberta, Canada.
Surg Endosc. 2004 Jun;18(6):969-73. doi: 10.1007/s00464-003-8262-2. Epub 2004 Apr 21.
The use of laparoscopic appendectomy for complicated appendicitis is controversial. Outcomes were compared between patients who had complicated appendicitis and those who had uncomplicated appendicitis.
Consecutive patients (n = 304) who underwent laparoscopic appendectomy were studied. Patients undergoing open appendectomies also were compared ad hoc. Analgesia use, length of hospital stay, return to activity, and complication rates for the complicated and uncomplicated appendicitis subgroups were analyzed.
Complete data were available for 243 patients (80%). There were no statistical differences in characteristics between the two groups. The operating times, lengths of hospital stay, return to activity times, complication rates, and analgesia requirements, both in the hospital and after discharge, were equivalent. A greater number of complicated cases required open conversion. Considering those with complicated appendicitis, the open group had a significantly longer mean hospital stay and a higher complication rate than those treated with laparoscopic appendectomy.
The minimally invasive laparoscopic technique is safe and efficacious. It should be the initial procedure of choice for most cases of complicated appendicitis.
腹腔镜阑尾切除术用于复杂性阑尾炎的治疗存在争议。对复杂性阑尾炎患者和非复杂性阑尾炎患者的治疗结果进行了比较。
对连续接受腹腔镜阑尾切除术的患者（n = 304）进行研究。还对接受开腹阑尾切除术的患者进行了临时比较。分析了复杂性和非复杂性阑尾炎亚组的镇痛药物使用情况、住院时间、恢复活动情况及并发症发生率。
243例患者（80%）有完整数据。两组患者的特征无统计学差异。手术时间、住院时间、恢复活动时间、并发症发生率以及住院期间和出院后的镇痛需求均相当。更多的复杂病例需要转为开腹手术。对于复杂性阑尾炎患者，开腹组的平均住院时间显著更长，并发症发生率高于接受腹腔镜阑尾切除术的患者。
微创腹腔镜技术安全有效。对于大多数复杂性阑尾炎病例，它应是首选的初始手术方式。
