Reissfelder C, Mc Cafferty B, von Frankenberg M
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Chirurgische Universitätsklinik, Im Neuenheimer Feld 110, Heidelberg, Germany.
Chirurg. 2009 Jul;80(7):602-7. doi: 10.1007/s00104-009-1683-2.
Acute appendicitis is the most common emergency visceral surgical procedure in Germany with 130,000 appendectomies. The question of which operational procedure should be used must therefore be discussed at regular intervals. In many centers of minimal invasive surgery, laparoscopic appendectomy (LA) is the standard procedure. Nearly 30 years after introduction of LA, it is believed that open appendectomy (OA) is needed only on rare occasions, but the actual percentage of OAs carried out in 2006 was 46% of all appendectomies. This high percentage documents that OA is still the standard procedure in many German hospitals. A review of the literature shows that there are still some situations in which OA is superior to LA. Infants younger than 5 years old have a more difficult basic requirement for LA due to the small abdominal cavity, therefore OA is the procedure of choice in most cases. During pregnancy OA has a lower risk for the fetus than LA. Cost analyses show that OA is less expensive for the hospital in material costs, whereas LA is the better economic choice due to an earlier return to work. In summary, there are only marginal differences between the two procedures since both offer a fast patient recovery. Advantages in favor of both LA and OA exist in subgroup analyses and the possible subgroups that can benefit from OA are discussed in this article.
急性阑尾炎是德国最常见的急诊内脏外科手术，每年有13万例阑尾切除术。因此，必须定期讨论应采用哪种手术方法。在许多微创手术中心，腹腔镜阑尾切除术（LA）是标准手术。在LA引入近30年后，人们认为仅在极少数情况下才需要进行开腹阑尾切除术（OA），但2006年实际进行的OA手术占所有阑尾切除术的46%。这一高比例表明OA在许多德国医院仍是标准手术。文献综述表明，仍有一些情况OA优于LA。5岁以下的婴儿由于腹腔较小，进行LA的基本条件更为困难，因此大多数情况下OA是首选手术。怀孕期间，OA对胎儿的风险低于LA。成本分析表明，OA对医院来说材料成本较低，而LA由于患者能更早重返工作岗位，在经济上是更好的选择。总之，这两种手术之间只有微小差异，因为两者都能使患者快速康复。亚组分析显示LA和OA都有优势，本文讨论了可能从OA中获益的亚组。
