Schmelzer Thomas M, Rana Ankur R, Walters K Christian, Norton H James, Bambini Daniel A, Heniford B Todd
Carolinas Medical Center, Department of Surgery and the Division of GI and Minimally Invasive Surgery, Charlotte, NC 28203, USA.
J Laparoendosc Adv Surg Tech A. 2007 Oct;17(5):693-7. doi: 10.1089/lap.2007.0070.
The appendectomy is a common emergent surgical procedure in the pediatric population. The aim of this study was to examine our institution's experience and outcomes in the appendectomy in the pediatric population early in our transition from open surgery to a predominantly laparoscopic approach.
We retrospectively studied all pediatric patients (age 20 years) that underwent an appendectomy at a tertiary care center over 2 years. The data collected included patient demographics, comorbidities, operative details, outcomes, and complications.
Two hundred twenty-three consecutive patients, with a mean age of 9.5 (3.9) years, were included in the study. Forty-four laparoscopic and 179 open appendectomies were performed. Two of the laparoscopic cases were converted to open appendectomies. Significant differences were seen between the two groups, with longer operative times (P < 0.0001) and lower estimated blood loss (P = 0.007) in the laparoscopic group. Operative times improved significantly for the laparoscopic group as the surgeons became more experienced (P = 0.03). The laparoscopic group used intravenous pain medication for a shorter time (0.8 vs. 1.9 days; P = 0.0003) and had a shorter postoperative hospital length of stay (2.2 vs. 3.4 days; P = 0.004). The laparoscopic group had fewer wound infections (2.3% vs. 6.2%; P = 0.3), intra-abdominal abscesses (4.5% vs. 5.6%; P = 0.8), and postoperative ileus (0% vs. 2.2%; P = 0.3), although these differences did not reach statistical significance.
The laparoscopic appendectomy procedure is a safe alternative to open appendectomy in pediatric patients and results in shorter hospital stays with less postoperative pain.
阑尾切除术是儿科常见的急诊外科手术。本研究的目的是在我们从开放手术向主要采用腹腔镜手术方式转变的早期阶段，考察本机构在儿科患者阑尾切除术中的经验和结果。
我们回顾性研究了在一家三级医疗中心2年期间接受阑尾切除术的所有儿科患者（年龄≤20岁）。收集的数据包括患者人口统计学资料、合并症、手术细节、结果和并发症。
223例连续患者纳入研究，平均年龄9.5（3.9）岁。其中44例进行了腹腔镜阑尾切除术，179例进行了开放阑尾切除术。2例腹腔镜手术转为开放手术。两组之间存在显著差异，腹腔镜组手术时间更长（P < 0.0001），估计失血量更低（P = 0.007）。随着外科医生经验增加，腹腔镜组手术时间显著缩短（P = 0.03）。腹腔镜组静脉使用止痛药物时间更短（0.8天对1.9天；P = 0.0003），术后住院时间更短（2.2天对3.4天；P = 0.004）。腹腔镜组伤口感染（2.3%对6.2%；P = 0.3）、腹腔内脓肿（4.5%对5.6%；P = 0.8）和术后肠梗阻（0%对2.2%；P = 0.3）较少，尽管这些差异未达到统计学意义。
在儿科患者中，腹腔镜阑尾切除术是开放阑尾切除术的安全替代方法，可缩短住院时间，减轻术后疼痛。
