腹腔镜与开腹阑尾切除术治疗儿童阑尾炎的疗效比较：基于全州分析的结果对比。

Laparoscopic versus open appendectomy in children: outcomes comparison based on a statewide analysis.

机构信息

Division of Pediatric Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7098, USA.

出版信息

J Surg Res. 2010 Jun 1;161(1):13-7. doi: 10.1016/j.jss.2009.06.033. Epub 2009 Jul 24.

DOI:10.1016/j.jss.2009.06.033

PMID:20031168

Abstract

BACKGROUND

To compare the differences in hospital utilization and complications between laparoscopic (LA) and open appendectomy (OA) for pediatric appendicitis.

METHODS

A retrospective study from 1999 to 2006 of children aged 1 to 18 y with appendicitis, from the California Patient Discharge Database was performed. Children with significant comorbidities were excluded. Initial hospital course, subsequent readmissions, and the need for additional procedures were analyzed.

RESULTS

The use of LA increased steadily from 19% in 1999 to 52% in 2006. Overall, 95,806 children were studied. Readmissions were tracked over a median period of 3 y. LA was associated with increased need for postoperative intra-abdominal abscess drainage for both perforated appendicitis (4.9% versus 3.8%, P<0.001) and nonperforated appendicitis (0.6% versus 0.3%, P<0.001) compared with OA. Multivariate regression showed an increased risk of postoperative abscess drainage for children after LA compared with OA (RR 1.81, 99% CI 1.41-2.27). However, the lengths of readmission hospitalizations were the same between the two groups (5.8 versus 5.7 d, P=NS).

CONCLUSION

LA has become the preferred operation for pediatric appendicitis. The need for postoperative abscess drainage is small, and laparoscopy appears to increase this risk slightly. However, LA did not affect long-term hospital utilizations.

摘要

背景

比较腹腔镜（LA）和开腹阑尾切除术（OA）治疗小儿阑尾炎的住院利用率和并发症差异。

方法

对 1999 年至 2006 年加利福尼亚患者出院数据库中 1 至 18 岁患有阑尾炎的儿童进行回顾性研究。排除有严重合并症的儿童。分析初始住院过程、后续再入院和需要额外手术的情况。

结果

LA 的使用率从 1999 年的 19%稳步上升到 2006 年的 52%。总体上，研究了 95806 名儿童。对中位数为 3 年的再入院情况进行了跟踪。LA 与 OA 相比，穿孔性阑尾炎（4.9%对 3.8%，P<0.001）和非穿孔性阑尾炎（0.6%对 0.3%，P<0.001）术后需要更多的腹腔脓肿引流。多变量回归显示，与 OA 相比，LA 后儿童发生术后脓肿引流的风险增加（RR 1.81，99%CI 1.41-2.27）。然而，两组的再入院住院时间相同（5.8 天对 5.7 天，P=NS）。