Visnjic S
Department of Pediatric Surgery, Children's Hospital Zagreb, Klaiceva 16, Zagreb, 10000, Croatia.
Surg Endosc. 2008 Jul;22(7):1667-71. doi: 10.1007/s00464-007-9680-3. Epub 2007 Dec 11.
Two different laparoscopic appendectomy (LA) techniques, one performed with staplers (LAS) and the other using loops (LAL), were compared with transumbilical laparoscopically assisted appendectomy (TULAA).
A total of 72 children, 55 with a diagnosis of uncomplicated acute appendicitis and 17 with recurrent right lower abdominal pain, underwent operation during the period 2003-2006. The procedures used were: 34 LAS, 9 LAL, and 29 TULAA. Measured outcomes were operative time, postoperative complications, need for rescue analgesics, length of hospital stay, and procedure cost reflected by supplies used. The staplers, endoloops, clips, and sutures used to manage appendectomy were listed at current prices, summarized as number consumed per case, and compared. Data were analyzed by Fisher's exact test and the Mann-Whitney U-test where appropriate. Statistical significance was determined as p < 0.05.
Average price of materials used was 113.5 USD for LAS, 91 USD for LAL, and 14 USD for TULAA. Wound infections were recorded in two patients (4.6%) in the LA group and in four patients (13.7%) in the TULAA group (p = 0.17). One patient in the LAL group developed an abdominal abscess that was managed conservatively. Median operating time was 39 (24-66) min in the LA group versus 33 (25-55) min in the TULAA group (p < 0.05). Rescue analgesia was administered in 19/43 (44%) of LA patients and 9/29 (31%) of TULAA patients (p = 0.19). The length of hospital stay was 3.1 days for LA patients and 3.0 days for TULAA patients (p = 0.43). Two TULAA procedures (6.4%) were finished with additional port/s.
In this study, the cost of TULAA is 7.8 times lower than the cost of LA, 8.1 times lower than LAS, and 6.5 times lower than LAL. Higher cost of laparoscopy is solely attributable to the purchase price of the supplies used. Overall postoperative morbidity, the incidence of wound infection, the length of hospitalization, and the need for rescue analgesia did not show a statistical difference in comparing LA/TULAA. Operative time was shorter in the TULAA group. In terms of limited resources, TULAA could be the most appropriate minimally invasive technique for appendectomy in children.
将两种不同的腹腔镜阑尾切除术（LA）技术，一种使用吻合器（LAS），另一种使用圈套器（LAL），与经脐腹腔镜辅助阑尾切除术（TULAA）进行比较。
2003年至2006年期间，共有72名儿童接受手术，其中55名诊断为单纯性急性阑尾炎，17名有右下腹复发性疼痛。所采用的手术方法为：34例LAS，9例LAL，29例TULAA。测量的结果包括手术时间、术后并发症、是否需要急救镇痛药、住院时间以及由所用耗材反映的手术费用。将用于阑尾切除术的吻合器、内镜圈套器、夹子和缝线按当前价格列出，汇总为每例消耗数量并进行比较。数据在适当情况下采用Fisher精确检验和Mann-Whitney U检验进行分析。统计学显著性判定为p < 0.05。
LAS所用材料的平均价格为113.5美元，LAL为91美元，TULAA为14美元。LA组有2例患者（4.6%）发生伤口感染，TULAA组有4例患者（13.7%）发生伤口感染（p = 0.17）。LAL组有1例患者发生腹部脓肿，经保守治疗。LA组的中位手术时间为39（24 - 66）分钟，TULAA组为33（25 - 55）分钟（p < 0.05）。LA组43例患者中有19例（44%）使用了急救镇痛药，TULAA组29例患者中有9例（31%）使用了急救镇痛药（p = 0.19）。LA组患者的住院时间为3.1天，TULAA组患者为3.0天（p = 0.43）。2例TULAA手术（6.4%）需要额外增加端口完成。
在本研究中，TULAA的费用比LA低7.8倍，比LAS低8.1倍，比LAL低6.5倍。腹腔镜手术费用较高完全归因于所用耗材的购买价格。总体术后发病率、伤口感染发生率、住院时间以及急救镇痛药的使用在比较LA/TULAA时未显示出统计学差异。TULAA组的手术时间较短。就资源有限而言，TULAA可能是儿童阑尾切除术最合适的微创技术。
