Kiriakopoulos Andreas, Tsakayannis Dimitrios, Linos Dimitrios
Department of Surgery, "Hygeia Hospital," Athens, Greece.
JSLS. 2006 Oct-Dec;10(4):453-6.
Complicated appendicitis is associated with a significant risk of postoperative morbidity, making the value of the minimally invasive approach controversial.
From January 2000 to October 2004, 42 patients with complicated appendicitis were categorized into 3 groups: Group 1--perforation, Group 2-abscess formation, and Group 3--generalized peritonitis. The conversion rate, the operative time, the mean hospital stay, the postoperative abdominal and wound infections, the return to oral intake, and the late obstructive complications were analyzed in relation to clinicopathological subgroupings.
Conversion was needed in 2 patients (4.8%) due to adenocarcinoma (Group 2) and technical difficulties (Group 1). Mean operative time was 67 minutes (range, 48 to 88), and mean hospital stay was 3.2 days (range, 2 to 5). No postoperative wound infection or intraabdominal abscess was encountered. A clear liquid diet was instituted at the first postoperative 24 hours, and the mean time of flatus passage was 26.5 hours (range, 19 to 31). No statistically significant differences in operative time (P=0.13) and flatus passage (P=0.18) were found among the 3 groups. Two cases of late intestinal obstruction were treated successfully with conservative measures.
Laparoscopic appendectomy is a safe, feasible treatment option in complicated appendicitis. It is not associated with increased risk of septic postoperative complications including wound infections and intraabdominal abscess formation.
复杂性阑尾炎术后发病风险显著，使得微创方法的价值存在争议。
2000年1月至2004年10月，42例复杂性阑尾炎患者被分为3组：第1组——穿孔，第2组——脓肿形成，第3组——弥漫性腹膜炎。根据临床病理亚组分析了中转率、手术时间、平均住院时间、术后腹部及伤口感染情况、恢复经口进食情况以及晚期梗阻性并发症。
2例患者（4.8%）因腺癌（第2组）和技术困难（第1组）需要中转。平均手术时间为67分钟（范围48至88分钟），平均住院时间为3.2天（范围2至5天）。未发生术后伤口感染或腹腔内脓肿。术后24小时开始给予清流食，平均排气时间为26.5小时（范围19至31小时）。3组之间手术时间（P = 0.13）和排气时间（P = 0.18）无统计学显著差异。2例晚期肠梗阻患者经保守治疗成功。
腹腔镜阑尾切除术是复杂性阑尾炎安全、可行的治疗选择。它与包括伤口感染和腹腔内脓肿形成在内的术后感染性并发症风险增加无关。
