腹腔镜与开腹手术治疗肥胖人群急性非穿孔与穿孔阑尾炎的比较。

Comparison of laparoscopic versus open appendectomy for acute nonperforated and perforated appendicitis in the obese population.

机构信息

Department of Surgery, University of California, Irvine, Medical Center, Orange, CA 92868, USA.

出版信息

Am J Surg. 2011 Dec;202(6):733-8; discussion 738-9. doi: 10.1016/j.amjsurg.2011.06.034. Epub 2011 Oct 11.

DOI:10.1016/j.amjsurg.2011.06.034

PMID:21992808

Abstract

BACKGROUND

Use of laparoscopic appendectomy (LA) has been increasing in obese patients. We evaluated the outcomes of LA compared with open appendectomy (OA) in obese patients.

METHODS

By using the Nationwide Inpatient Sample database, clinical data of obese patients who underwent LA and OA for suspected acute appendicitis (perforated or nonperforated) from 2006 to 2008 were examined.

RESULTS

A total of 42,426 obese patients underwent an appendectomy during this period. In acute nonperforated cases, LA had a lower overall complication rate (7.17% vs 11.72%; P < .01), mortality rate (.09% vs .23%; P < .01), mean hospital charges ($25,193 vs $26,380; P = .04), and shorter mean length of stay (2.0 vs 3.1 d; P < .01) compared with OA. Similarly, in perforated cases, LA was associated with a lower overall complication rate (22.34% vs 34.65%; P < .01), mortality rate (.0% vs .50%; P < .01), mean hospital charges ($36,843 vs $43,901; P < .01), and a shorter mean length of stay (4.4 vs 6.5 d; P < .01) compared with OA.

CONCLUSIONS

LA can be performed safely with superior outcomes compared with OA in obese patients and should be considered the procedure of choice for perforated and nonperforated appendicitis in these patients.

摘要

背景

腹腔镜阑尾切除术（LA）在肥胖患者中的应用越来越多。我们评估了 LA 与开放阑尾切除术（OA）治疗肥胖患者急性阑尾炎（穿孔或未穿孔）的结果。

方法

利用全国住院患者样本数据库，对 2006 年至 2008 年期间接受 LA 和 OA 治疗疑似急性阑尾炎（穿孔或未穿孔）的肥胖患者的临床数据进行了检查。

结果

共有 42426 名肥胖患者在此期间接受了阑尾切除术。在急性非穿孔病例中，LA 的总并发症发生率（7.17%比 11.72%；P<.01）、死亡率（0.09%比 0.23%；P<.01）、平均住院费用（$25193 比$26380；P=.04）和平均住院时间（2.0 比 3.1 d；P<.01）均低于 OA。同样，在穿孔病例中，LA 的总并发症发生率（22.34%比 34.65%；P<.01）、死亡率（0.0%比 0.50%；P<.01）、平均住院费用（$36843 比$43901；P<.01）和平均住院时间（4.4 比 6.5 d；P<.01）均低于 OA。