Howard University Hospital, Division of Minimally Invasive and Bariatric Surgery, Washington, DC 20060, USA.
J Surg Res. 2010 Oct;163(2):225-8. doi: 10.1016/j.jss.2010.03.071. Epub 2010 May 15.
Laparoscopic appendectomy (LA) has been an established treatment method for uncomplicated acute appendicitis. Controversy still exits regarding the superiority of either laparoscopic or open technique for the treatment of complicated appendicitis.
To examine for benefits in postoperative morbidity comparing laparoscopic versus open appendectomy for complicated appendicitis.
A retrospective analysis was performed using the American College of Surgeon's National Surgical Quality Improvement Project (ACS-NSQIP) dataset between 2005 and 2007. Inclusion criteria were patients undergoing either open or laparoscopic appendectomy, and had complicated appendicitis. Patients with negative appendectomies and age less than 18 y old were excluded. The primary outcome variable was postoperative complications. Multivariate analysis was performed adjusting for demographics and standard NSQIP comorbidities.
We identified 2,790 complicated appendicitis cases treated with laparoscopic or open appendectomy. The majority were male (56.6%), White (70.3%), and 39.1% were younger than 40 y of age. On unadjusted analyses, the mean length of stay was significantly shorter for LA cases (3.97 d) than OA cases (5.13 d) (P < 0.001). On multivariate analysis, superficial surgical site infection was 70% less likely to occur in LA (OR 0.304 P = 0.000), organ space infection was 2-fold more likely to occur in LA (OR 2.19 P = 0.003), and dehiscence was 78% less likely to occur in LA (OR 0.22 P = 0.015).
In cases of complicated appendicitis, laparoscopic appendectomy is superior in terms of superficial and deep wound infections; however, it is associated with an increased incidence of postoperative intra-abdominal abscess.
腹腔镜阑尾切除术（LA）已成为治疗单纯性急性阑尾炎的一种既定治疗方法。对于复杂性阑尾炎，腹腔镜与开腹技术哪种更具优势仍存在争议。
比较腹腔镜与开腹阑尾切除术治疗复杂性阑尾炎的术后发病率优势。
使用美国外科医师学院国家手术质量改进计划（ACS-NSQIP）数据库，对 2005 年至 2007 年期间进行的回顾性分析。纳入标准为接受开腹或腹腔镜阑尾切除术且患有复杂性阑尾炎的患者。排除阴性阑尾切除术和年龄小于 18 岁的患者。主要结局变量是术后并发症。采用多变量分析调整人口统计学和标准 NSQIP 合并症。
我们确定了 2790 例接受腹腔镜或开腹阑尾切除术治疗的复杂性阑尾炎病例。大多数患者为男性（56.6%），白人（70.3%），39.1%的患者年龄小于 40 岁。在未调整的分析中，LA 组的平均住院时间明显短于 OA 组（3.97 d 比 5.13 d）（P < 0.001）。多变量分析显示，LA 组发生浅表手术部位感染的可能性降低 70%（OR 0.304，P = 0.000），发生器官间隙感染的可能性增加 2 倍（OR 2.19，P = 0.003），发生切口裂开的可能性降低 78%（OR 0.22，P = 0.015）。
在复杂性阑尾炎的情况下，腹腔镜阑尾切除术在浅表和深部伤口感染方面具有优势；然而，它与术后腹腔脓肿的发生率增加有关。
