Malagon Antonio M, Arteaga-Gonzalez Ivan, Rodriguez-Ballester Lucrecia
Department of General Surgery, Hospital Universitario de Canarias, La Laguna, Canary Islands, Spain.
J Laparoendosc Adv Surg Tech A. 2009 Dec;19(6):721-5. doi: 10.1089/lap.2009.0167.
Laparoscopic treatment of simple acute appendicitis (AA) is a safe procedure; however, there are doubts about its safety in cases of complicated AA. The aim of this study was to determine the differences in results of laparoscopic treatment between cases of complicated versus simple AA.
We prospectively included all patients treated for suspected AA by two surgeons of our service between May 2002 and May 2007. Of 221 patients, 20 were excluded from the study because the laparoscopic approach was not possible; 116 of 201 had uncomplicated AA, 57 complicated AA, 12 gynecologic ethiology, 11 negative appendectomy, and 5 other causes; patients without acute appendicitis were also excluded from the study. In all cases, laparoscopy was the first treatment option. The following variables were considered: mean surgical time, reconversions, emergency readmissions, emergency reinterventions or invasive procedures, mean postoperative hospital stay, and postoperative complications (i.e., infectious or noninfectious).
Our results showed statistically significantly worse results, in terms of surgical time, postoperative stay, reconversions, and infectious complications, for patients with complicated versus uncomplicated AA; however, no differences were observed regarding noninfectious complications, emergency readmissions, and emergency reinterventions or invasive procedures.
We consider that laparoscopic treatment of complicated AA may be safely used, despite worse results than in cases of simple AA, since the differences in numbers of severe postoperative complications requiring emergency readmission, reintervention, or invasive procedures were not statistically significant.
腹腔镜治疗单纯性急性阑尾炎（AA）是一种安全的手术方法；然而，对于复杂性AA病例，其安全性存在疑问。本研究的目的是确定复杂性AA与单纯性AA病例在腹腔镜治疗结果上的差异。
我们前瞻性纳入了2002年5月至2007年5月期间由我们科室的两位外科医生治疗的所有疑似AA患者。在221例患者中，20例因无法采用腹腔镜手术而被排除在研究之外；201例患者中，116例为非复杂性AA，57例为复杂性AA，12例为妇科病因，11例为阴性阑尾切除术，5例为其他原因；无急性阑尾炎的患者也被排除在研究之外。在所有病例中，腹腔镜检查是首选治疗方法。考虑了以下变量：平均手术时间、再次手术、急诊再入院、急诊再次干预或侵入性操作、平均术后住院时间以及术后并发症（即感染性或非感染性）。
我们的结果显示，在手术时间、术后住院时间、再次手术和感染性并发症方面，复杂性AA患者的结果在统计学上明显比非复杂性AA患者差；然而，在非感染性并发症、急诊再入院以及急诊再次干预或侵入性操作方面未观察到差异。
我们认为，尽管结果比单纯性AA病例差，但腹腔镜治疗复杂性AA仍可安全使用，因为需要急诊再入院、再次干预或侵入性操作的严重术后并发症数量差异无统计学意义。
