Kargar Saeed, Mirshamsi Mohammad Hussein, Zare Mohammad, Arefanian Saeed, Shadman Yazdi Elham, Aref Asiah
Department of Surgery, General Surgeon, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Acta Med Iran. 2011;49(6):352-6.
Appendicitis is the most common surgical emergency with the incidence rate of 6-10%. Although several studies have compared the two approaches of open (OA) and laparoscopic appendectomy (LA) the technique of choice is still a matter of controversy. Considering this background we designed a study to compare OA and LA outcomes in our center. One hundred patients were included in this study performed from April 2008 to April 2009 at Shahid Sadoughi hospital, Yazd, Iran. Patients who gave informed consent were randomized to either OA or LA groups and were operated by McBurney's or laparoscopic technique, respectively. Patients received our center's routine diet, antibiotics and analgesic regimens. The patients' pain was measured by visual analogue scale (VAS) at their entrance to the recovery room and in 6-hour intervals up to 24 hours. Post-operation follow up visits were in weeks 1, 2 and 4. The data of operation time, hospital stay, intra-operation complications, time to resume normal activity, short term complications and neuralgia were collected and analysed. The average operation time was 34.4±8.42 min in LA and 41.7±8.84 in OA hand (P=0001). No intra-operative complication and no LA to OA conversion were encountered in operations. Post-operative complication rate was higher in OA group (n=10) compared to LA (n=3). The post-operative pain showed less pain in OA only at 6 and 12 hours post-operative times. Patients' mean hospital stay was 52.32±19.2 and 42.96±13.8 hours in LA and OA groups, respectively (P=0.003). Time to resume normal activity didn't show a significant difference between two groups (P=0.53). Only one case of neuralgia in the OA group was confronted in the follow up visits. LA has less complications and cosmetic scar with the cost of more pain. Decision between OA and LA for each patient should be made individually.
阑尾炎是最常见的外科急症，发病率为6%至10%。尽管有多项研究比较了开放手术（OA）和腹腔镜阑尾切除术（LA）这两种方法，但选择何种技术仍存在争议。考虑到这一背景，我们设计了一项研究来比较我们中心OA和LA的手术效果。本研究纳入了2008年4月至2009年4月在伊朗亚兹德的沙希德·萨多吉医院进行手术的100例患者。签署知情同意书的患者被随机分为OA组或LA组，分别采用麦氏切口或腹腔镜技术进行手术。患者接受我们中心的常规饮食、抗生素和镇痛方案。在患者进入恢复室时以及术后24小时内每隔6小时，通过视觉模拟评分法（VAS）测量患者的疼痛程度。术后随访分别在第1、2和4周进行。收集并分析手术时间、住院时间、术中并发症、恢复正常活动时间、短期并发症和神经痛等数据。LA组的平均手术时间为34.4±8.42分钟，OA组为41.7±8.84分钟（P = 0.001）。手术中未发生术中并发症，也没有LA转为OA的情况。OA组的术后并发症发生率（n = 10）高于LA组（n = 3）。术后疼痛仅在术后6小时和12小时时OA组的疼痛较轻。LA组和OA组患者的平均住院时间分别为52.32±19.2小时和42.96±13.8小时（P = 0.003）。两组恢复正常活动的时间没有显著差异（P = 0.53）。随访中仅OA组有1例出现神经痛。LA的并发症较少，美容效果更好，但代价是疼痛更明显。对于每个患者，应单独决定采用OA还是LA。
