Tanaka Shogo, Kubota Daisuke, Lee Sang Hun, Oba Kazuki, Matsuyama Mitsuharu
Department of Surgery, Joto Central Hospital, Osaka, Japan.
Osaka City Med J. 2007 Jun;53(1):1-8.
Whether a laparoscopic approach is more effective for acute appendicitis than standard open appendectomy remains controversial.
Clinical records of the 95 consecutive patients who underwent appendectomy for acute appendicitis between April 2002 and December 2005 were reviewed retrospectively. Laparoscopic appendectomy was performed for 62 patients (LA group), while 33 underwent open appendectomy (OA group). At our institution, LA is a standard operative procedure for acute appendicitis, and OA underwent because of social reasons. Characteristics, operative factors, and postoperative course were compared between groups.
Age, gender, past appendicitis attacks managed conservatively, and preoperative white blood cell counts did not differ significantly. Pathologic severity of appendicitis was more advanced in the OA than LA group (gangrenous in 52% vs 21% respectively, p=0.009). Mean operative time was significantly longer in the LA than OA group (80 min vs 63 min respectively, p=0.012). Pre- and postoperative white blood cell counts did not differ between groups, but recovery from postoperative pain and fever was significantly earlier in the LA than OA group (p=0.0007 and 0.013, respectively). Postoperative wound infection was significantly less frequent in the LA (6%) than OA group (27%, p=0.01), while incidence of postoperative intraabdominal infection did not differ significantly. Two patients in the LA group had serious complications that required reoperation; postoperative bleeding from the coagulated mesoappendix in one, and perforation of the jejunum caused by electrocautery during trocar insertion in the other. Mean postoperative hospital stay was significantly shorter in the LA than OA group (6.7 and 14.4 days respectively, p=0.04). According to severity of appendicitis, LA had no advantages over OA for gangrenous appendicitis.
Laparoscopic appendectomy has some disadvantages, such as long operative time and possible of serious complications, but generally accelerates postoperative early recovery to shorten hospitalization.
对于急性阑尾炎，腹腔镜手术方法是否比标准的开腹阑尾切除术更有效仍存在争议。
回顾性分析2002年4月至2005年12月间连续95例行急性阑尾炎阑尾切除术患者的临床记录。62例患者行腹腔镜阑尾切除术（LA组），33例患者行开腹阑尾切除术（OA组）。在我们机构，LA是急性阑尾炎的标准手术方式，而OA是由于社会原因进行的。比较两组患者的特征、手术因素及术后病程。
年龄、性别、既往保守治疗的阑尾炎发作次数及术前白细胞计数差异无统计学意义。阑尾炎的病理严重程度在OA组比LA组更严重（分别为坏疽性52%对21%，p = 0.009）。LA组的平均手术时间显著长于OA组（分别为80分钟对63分钟，p = 0.012）。两组术前和术后白细胞计数差异无统计学意义，但LA组术后疼痛和发热的恢复明显早于OA组（分别为p = 0.0007和0.013）。LA组术后伤口感染发生率（6%）显著低于OA组（27%，p = 0.01），而术后腹腔内感染发生率差异无统计学意义。LA组有2例患者出现严重并发症需要再次手术；1例为凝固的阑尾系膜术后出血，另1例为套管针插入时电灼导致空肠穿孔。LA组术后平均住院时间显著短于OA组（分别为6.7天和14.4天，p = 0.04）。根据阑尾炎的严重程度，对于坏疽性阑尾炎，LA组相对于OA组无优势。
腹腔镜阑尾切除术有一些缺点，如手术时间长和可能出现严重并发症，但总体上可加速术后早期恢复以缩短住院时间。
