Shaikh Abdul Razak, Sangrasi Ahmed Khan, Shaikh Gulshan Ara
Liaquat University of Medical & Health Sciences Jamshoro, Sindh, Pakistan.
JSLS. 2009 Oct-Dec;13(4):574-80. doi: 10.4293/108680809X1258998404524.
Appendectomy, being the most common surgical procedure performed in general surgery, is still being performed by both open and laparoscopic methods due to a lack of consensus as to which is the most appropriate method. Because further trials are necessary and few such studies have been performed in developing countries, we decided to evaluate the outcomes of the 2 procedures to share our experience with the international community.
Consecutive patients with suspected acute appendicitis who underwent laparoscopic (LA) (n=48) and open (n=52) appendectomy (OA) over a period of 3 years were studied. Clinical outcomes were compared between the 2 groups in relation to operative time, analgesia used, length of hospital stay, return to work, resumption of a regular diet, and postoperative complications.
Mean age of patients was 25.8 years in the laparoscopic and 25.5 years in the open group. Patient demographics were similar in both groups (P>0.05). There was significantly less need for analgesia (1.0+/-0.5 in LA and 1.5+/-0.6 doses in OA), a short hospital stay (1.4+/-0.7 in LA and 3.4+/-1.0 days in OA), early return to work (12.6+/-3.3 in LA and 19.1+/-3.1 days in OA), and less time needed to return to a regular diet (20.1+/-2.9 in LA and 22.0+/-4.7, P<0.05 in OA) in the laparoscopic appendectomy group. Operative time was significantly shorter (54.9+/-14.7 in LA and 13.6+/-12.6 minutes in OA) in the open group. Total number of complications was less in the laparoscopic group; however, there was no statistically significant difference.
The laparoscopic technique is a safe and clinically beneficial operative procedure. It provides certain advantages over open appendectomy, including short hospital stay, decreased requirement of postoperative analgesia, early food tolerance, and earlier return to normal activities. Where feasible, laparoscopy should be undertaken as the initial procedure of choice for most cases of suspected appendicitis.
阑尾切除术是普通外科最常见的手术，但由于对于哪种方法最合适缺乏共识，目前仍通过开放手术和腹腔镜手术两种方式进行。由于需要进一步试验，且在发展中国家很少进行此类研究，我们决定评估这两种手术的结果，以便与国际社会分享我们的经验。
对连续3年接受腹腔镜阑尾切除术（LA）（n = 48）和开放阑尾切除术（OA）（n = 52）的疑似急性阑尾炎患者进行研究。比较两组在手术时间、使用的镇痛方法、住院时间、恢复工作时间、恢复正常饮食时间以及术后并发症方面的临床结果。
腹腔镜组患者的平均年龄为25.8岁，开放组为25.5岁。两组患者的人口统计学特征相似（P>0.05）。腹腔镜阑尾切除术组在镇痛需求（LA组为1.0±0.5剂，OA组为1.5±0.6剂）、住院时间短（LA组为1.4±0.7天，OA组为3.4±1.0天）、早期恢复工作（LA组为12.6±3.3天，OA组为19.1±3.1天）以及恢复正常饮食所需时间（LA组为20.1±2.9天，OA组为22.0±4.7天，P<0.05）方面明显较少。开放组的手术时间明显更短（LA组为54.9±14.7分钟，OA组为13.6±12.6分钟）。腹腔镜组的并发症总数较少；然而，差异无统计学意义。
腹腔镜技术是一种安全且具有临床益处的手术方法。与开放阑尾切除术相比，它具有某些优势，包括住院时间短、术后镇痛需求减少、早期食物耐受性好以及更早恢复正常活动。在可行的情况下，对于大多数疑似阑尾炎病例，应首选腹腔镜手术作为初始手术方法。
