Katsuno Goutaro, Nagakari Kunihiko, Yoshikawa Seiichiro, Sugiyama Kazuyoshi, Fukunaga Masaki
Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, 2-1-1 Tomioka, Urayasu, 279-0021, Japan.
World J Surg. 2009 Feb;33(2):208-14. doi: 10.1007/s00268-008-9843-y.
Although laparoscopic appendectomy (LA) is widely performed in many countries, LA for complicated appendicitis, which includes perforated or gangrenous appendicitis with or without localized or disseminated peritonitis, has not become a common practice yet.
We retrospectively analyzed the clinical records of 230 patients who had undergone appendectomy for complicated appendicitis: 141 had undergone LA, 84 had conventional open appendectomy (OA), and 5 patients had conversion to the open procedure after laparoscopy. The LA group (total LA) was subdivided into "early experience (early LA: cases 1-56)" and "late experience (late LA: case 57 and higher)." We defined the early LA group as the comparison group to minimize selection bias.
Patient demographics were similar in the early LA and OA groups (P > 0.05). Wound infection was significantly more frequent in the OA group (P < 0.05). Intra-abdominal infection was equally common in these two groups. The overall rate of postoperative complications was significantly higher in the OA group (32.1%) than in the early LA group (18%; P < 0.05). This incidence was 12.8% in the total LA group. Hospital stay was significantly shorter in the early LA group (10.6 +/- 3.9 days; P < 0.05), and 8.9 +/- 3.7 days in the total LA group.
Our findings indicate that LA is safe and useful even for the treatment of complicated appendicitis if performed by an experienced surgeon.
尽管腹腔镜阑尾切除术（LA）在许多国家广泛开展，但对于复杂阑尾炎（包括伴有或不伴有局限性或弥漫性腹膜炎的穿孔性或坏疽性阑尾炎）的LA尚未成为一种常见的术式。
我们回顾性分析了230例因复杂阑尾炎接受阑尾切除术患者的临床记录：141例行LA，84例行传统开放性阑尾切除术（OA），5例在腹腔镜检查后转为开放手术。LA组（全LA组）又分为“早期经验（早期LA：病例1 - 56）”和“晚期经验（晚期LA：病例57及更高）”。我们将早期LA组定义为比较组以尽量减少选择偏倚。
早期LA组和OA组患者的人口统计学特征相似（P > 0.05）。OA组伤口感染明显更频繁（P < 0.05）。这两组腹腔内感染同样常见。OA组术后并发症的总体发生率（32.1%）明显高于早期LA组（18%；P < 0.05）。全LA组的这一发生率为12.8%。早期LA组住院时间明显更短（10.6 ± 3.9天；P < 0.05），全LA组为8.9 ± 3.7天。
我们的研究结果表明，如果由经验丰富的外科医生进行，LA即使对于复杂阑尾炎的治疗也是安全且有效的。
