Li Peng, Xu Quan, Ji Zongzheng, Gao Ya, Zhang Xiansheng, Duan Yitao, Guo Zhengtuan, Zheng Baijun, Guo Xinkui, Wu Xuanlin
Department of Pediatric Surgery, the Second Hospital of Xi'an Jiaotong University, Xi'an 710004, China.
J Pediatr Surg. 2005 Aug;40(8):1279-83. doi: 10.1016/j.jpedsurg.2005.05.011.
The present study aimed to evaluate laparoscopic appendectomy (LA) in comparison with conventional open appendectomy (OA) in children, with special emphasis on the extent of surgical trauma after LA and OA, and to assess whether LA had any clear advantages compared with conventional OA.
A total of 160 patients with a median age of 7.9 years (range 3-15 years) were studied. Sixty-nine of them underwent LA, and the remaining 91 underwent OA. Serum interleukin (IL) 6 and C-reactive protein (CRP) levels which are thought to play a pivotal role in the pathogenesis of surgical trauma and can also be used to monitor the magnitude of surgical trauma were measured using an enzyme-linked immunosorbent assay before surgery and 12 hours after surgery. In addition, we compared operating time, hospital stay, incidence of wound infection, and incidence of intra-abdominal infection.
The operative time of normal and suppurative appendix in the laparoscopic group was significantly shorter than that in the open group, respectively, but the operative time of gangrenous appendix was not different between the laparoscopic group and open group. The hospital stay in the laparoscopic group was also significantly shorter than that in the open group. Postoperatively, 1 patient had port-site infection in the laparoscopic group, whereas 10 had wound infection in the open group; this difference was highly significant (chi2 = 4.19, P < .05). Three patients in the open group and 2 patients in the laparoscopic group had intra-abdominal infection, and the difference had no statistically significant difference (chi2 = 0.10, P < .05). Preoperative IL-6 levels were not different between the 2 groups, but the rise (preoperative vs postoperative) of IL-6 in the laparoscopic group was remarkably less than that in the open group. Similar results were obtained for CRP; serum CRP levels in the basal state were not different between the 2 groups, but the rise (preoperative vs postoperative) of CRP in the laparoscopic group was also substantially less compared with that in the open group.
LA for children was as safe and effective as the open procedure and had significant advantages over OA because of less operating time, less postoperative complications, less surgical trauma, and more rapid postoperative recovery.
本研究旨在评估儿童腹腔镜阑尾切除术（LA）与传统开放式阑尾切除术（OA），特别强调LA和OA术后的手术创伤程度，并评估LA与传统OA相比是否具有明显优势。
共研究了160例患者，中位年龄为7.9岁（范围3 - 15岁）。其中69例行LA，其余91例行OA。使用酶联免疫吸附测定法在手术前和手术后12小时测量血清白细胞介素（IL）6和C反应蛋白（CRP）水平，这些指标被认为在手术创伤的发病机制中起关键作用，也可用于监测手术创伤的程度。此外，我们比较了手术时间、住院时间、伤口感染发生率和腹腔内感染发生率。
腹腔镜组正常阑尾和化脓性阑尾的手术时间分别显著短于开放组，但坏疽性阑尾的手术时间在腹腔镜组和开放组之间无差异。腹腔镜组的住院时间也显著短于开放组。术后，腹腔镜组有1例发生穿刺孔感染，而开放组有10例发生伤口感染；这种差异具有高度显著性（χ² = 4.19，P < 0.05）。开放组有3例患者和腹腔镜组有2例患者发生腹腔内感染，差异无统计学意义（χ² = 0.10，P < 0.05）。两组术前IL - 6水平无差异，但腹腔镜组IL - 6的升高（术前与术后）明显低于开放组。CRP也得到了类似的结果；两组基础状态下的血清CRP水平无差异，但腹腔镜组CRP的升高（术前与术后）也明显低于开放组。
儿童LA与开放手术一样安全有效，并且由于手术时间短、术后并发症少、手术创伤小以及术后恢复更快，与OA相比具有显著优势。
