Nadler Evan P, Reblock Kimberly K, Qureshi Faisal G, Hackam David J, Gaines Barbara A, Kane Timothy D
Division of Pediatric Surgery and Department of Surgery, New York University School of Medicine, New York, New York 10016, USA.
J Laparoendosc Adv Surg Tech A. 2006 Apr;16(2):159-63. doi: 10.1089/lap.2006.16.159.
There is persistent controversy regarding the optimal surgical therapy for children with appendicitis. We have recently adopted laparoscopic appendectomy in lieu of the open technique for children with perforated appendicitis. We hypothesized that laparoscopic appendectomy would be as effective as open appendectomy in preventing postoperative complications.
We reviewed the medical records of children admitted to our hospital over a 5-year period with the diagnosis of perforated appendicitis. Patients were divided into two groups based on the operative approach: laparoscopic vs. open appendectomy. Demographic data, duration of presenting symptoms, initial white blood cell (WBC) count, length of stay, and complications were abstracted. Data were compared using appropriate statistical analyses.
There was no difference between the laparoscopic (n = 43) and open (n = 77) groups with respect to gender, duration of presenting symptoms, initial WBC, or length of stay. However, patients in the laparoscopic group had a significantly lower complication rate than those in the open group (6/43 vs. 23/77, P = 0.05). Infectious complications were no different between groups. Patients in the laparoscopic group tended to be older than patients in the open group (10.6 +/- 3.3 years vs. 8.5 +/- 4.1 years, P = 0.003).
Laparoscopic appendectomy for children with perforated appendicitis has the same infectious complication rate and a lower overall complication rate than open appendectomy. A prospective study with standardized postoperative care would be needed to determine whether laparoscopic appendectomy for children with perforated appendicitis is the treatment of choice, but until then it remains an attractive alternative.
对于阑尾炎患儿的最佳手术治疗方法一直存在争议。我们最近采用腹腔镜阑尾切除术替代开放性手术治疗穿孔性阑尾炎患儿。我们假设腹腔镜阑尾切除术在预防术后并发症方面与开放性阑尾切除术效果相同。
我们回顾了我院5年间收治的诊断为穿孔性阑尾炎患儿的病历。根据手术方式将患者分为两组：腹腔镜阑尾切除术组与开放性阑尾切除术组。提取人口统计学数据、症状出现的持续时间、初始白细胞（WBC）计数、住院时间和并发症情况。使用适当的统计分析方法对数据进行比较。
腹腔镜组（n = 43）和开放性手术组（n = 77）在性别、症状出现的持续时间、初始白细胞计数或住院时间方面没有差异。然而，腹腔镜组患者的并发症发生率明显低于开放性手术组（6/43对23/77，P = 0.05）。两组间感染性并发症无差异。腹腔镜组患者的年龄往往比开放性手术组患者大（10.6±3.3岁对8.5±4.1岁，P = （0.003）。
对于穿孔性阑尾炎患儿，腹腔镜阑尾切除术与开放性阑尾切除术的感染性并发症发生率相同，但总体并发症发生率更低。需要进行一项具有标准化术后护理的前瞻性研究，以确定腹腔镜阑尾切除术是否为穿孔性阑尾炎患儿的首选治疗方法，但在此之前，它仍然是一个有吸引力的替代方案。
