腹腔镜检查在当代急性阑尾炎治疗中的应用

Laparoscopy in the contemporary management of acute appendicitis.

作者信息

Ekeh Akpofure Peter, Wozniak Curtis J, Monson Benjamin, Crawford Joseph, McCarthy Mary C

机构信息

Department of Surgery, Wright State University, CHE 7000, Miami Valley Hospital, 1 Wyoming Street, Dayton, OH 45459, USA.

出版信息

Am J Surg. 2007 Mar;193(3):310-3; discussion 313-4. doi: 10.1016/j.amjsurg.2006.09.025.

DOI:10.1016/j.amjsurg.2006.09.025

PMID:17320525

Abstract

BACKGROUND

We sought to compare laparoscopic appendectomy (LA) with open appendectomy (OA) focusing on the negative appendectomy rate (NAR), emergency department (ED) to operating room (OR) time, procedure length, and histopathological correlation.

METHODS

All appendectomies for appendicitis over a 6-year period at a single hospital were reviewed. Open and laparoscopic procedures were compared.

RESULTS

There were 1,312 appendectomies (54.6% OA and 45.4% LA) Mean ED to OR time was as follows: LA 10.8 hours (standard deviation [SD] +/- 9.0) versus 9.8 hours (SD +/- 8.5) OA (P = .0333). Mean OR time was 61.2 minutes (SD +/- 29.1) LA versus 57.7 minutes (SD +/- 28) OA (P = .0293). NAR was 18.3%, LA 23.3% versus 14.0% OA (P < .0001). Postoperative correlation with histopathology was 86% for LA versus 92% OA (P = .0003). In the LA group, 9.9% with a "normal" appendix had appendicitis by histopathology.

CONCLUSIONS

LA is associated with increased presentation to procedure time, operative time, and negative appendectomy rate. Removing a "normal" appendix during LA in the absence of alternate pathology is recommended.

摘要

背景

我们旨在比较腹腔镜阑尾切除术（LA）和开腹阑尾切除术（OA），重点关注阴性阑尾切除率（NAR）、急诊科（ED）至手术室（OR）的时间、手术时长以及组织病理学相关性。

方法

回顾了一家医院6年间所有因阑尾炎进行的阑尾切除术。对开腹手术和腹腔镜手术进行了比较。

结果

共进行了1312例阑尾切除术（54.6%为OA，45.4%为LA）。ED至OR的平均时间如下：LA为10.8小时（标准差[SD]±9.0），而OA为9.8小时（SD±8.5）（P = 0.0333）。平均手术时间LA为61.2分钟（SD±29.1），OA为57.7分钟（SD±28）（P = 0.0293）。NAR为18.3%，LA为23.3%，OA为14.0%（P < 0.0001）。LA术后与组织病理学的相关性为86%，OA为92%（P = 0.0003）。在LA组中，9.9%阑尾外观“正常”的患者经组织病理学检查患有阑尾炎。