对于老年患者，腹腔镜阑尾切除术比开腹阑尾切除术有优势吗？
Does laparoscopic appendectomy impart an advantage over open appendectomy in elderly patients?
作者信息
Masoomi Hossein, Mills Steven, Dolich Matthew O, Ketana Noor, Carmichael Joseph C, Nguyen Ninh T, Stamos Michael J
机构信息
Department of Surgery, University of California, Irvine Medical Center, 333 City Blvd. West Suite 700, Orange, CA 92868, USA.
出版信息
World J Surg. 2012 Jul;36(7):1534-9. doi: 10.1007/s00268-012-1545-9.
BACKGROUND
The use of laparoscopy in the elderly has been increasing in recent years. The data comparing laparoscopic (LA) with open appendectomy (OA) in elderly patients are minimal. We evaluated outcomes of LA versus OA in perforated and nonperforated appendicitis in elderly patients (aged ≥ 65 years).
METHODS
Using the Nationwide Inpatient Sample database, clinical data of elderly patients who underwent LA and OA for suspected acute appendicitis were evaluated from 2006 to 2008.
RESULTS
A total of 65,464 elderly patients underwent urgent appendectomy during this period. The rate of perforated appendicitis was twice as high in elderly patients (50 vs. 25%, p < 0.01) and rate of LA in elderly patients was lower (52 vs. 63%, p < 0.01) compared with patients younger than aged 65 years. Utilization of LA increased 24% from 46.5% in 2006 to 57.8% in 2008 (p < 0.01). In elderly patients with acute nonperforated appendicitis, LA had lower overall complication rate (15.82 vs. 23.49%, p < 0.01), in-hospital mortality (0.39 vs. 1.31%, p < 0.01), hospital charges ($30,414 vs. $34,095, p < 0.01), and mean length of stay (3.0 vs. 4.8 days, p < 0.01) compared with OA. Additionally, in perforated appendicitis in elderly patients, LA was associated with lower overall complication rate (36.27 vs. 46.92%, p < 0.01), in-hospital mortality (1.4 vs. 2.63%, p < 0.01), mean hospital charges ($43,339 vs. $57,943, p < 0.01), and shorter mean LOS (5.8 vs. 8.7 days, p < 0.01).
CONCLUSIONS
Laparoscopic appendectomy can be performed safely with significant advantages compared with open appendectomy in the elderly and should be considered the procedure of choice for perforated and nonperforated appendicitis in these patients.
背景
近年来，腹腔镜检查在老年人中的应用日益增多。关于老年患者腹腔镜阑尾切除术（LA）与开腹阑尾切除术（OA）对比的数据极少。我们评估了老年患者（年龄≥65岁）中LA与OA治疗穿孔性和非穿孔性阑尾炎的疗效。
方法
利用全国住院患者样本数据库，对2006年至2008年因疑似急性阑尾炎接受LA和OA的老年患者的临床数据进行评估。
结果
在此期间，共有65464名老年患者接受了急诊阑尾切除术。与年龄小于65岁的患者相比，老年患者的穿孔性阑尾炎发生率更高（50%对25%，p<0.01），且老年患者的LA率更低（52%对63%，p<0.01）。LA的使用率从2006年的46.5%增加到2008年的57.8%，增长了24%（p<0.01）。在老年急性非穿孔性阑尾炎患者中，与OA相比，LA的总体并发症发生率更低（15.82%对23.49%，p<0.01），住院死亡率更低（0.39%对1.31%，p<0.01），住院费用更低（30414美元对34095美元，p<0.01），平均住院时间更短（3.0天对4.8天，p<0.01）。此外，在老年穿孔性阑尾炎患者中，LA与更低的总体并发症发生率（36.27%对46.92%，p<0.01）、住院死亡率（1.4%对2.63%，p<0.01）、平均住院费用（43339美元对57943美元，p<0.01）以及更短的平均住院时间（5.8天对8.7天，p<0.01）相关。
结论
与开腹阑尾切除术相比，腹腔镜阑尾切除术在老年患者中可安全进行，且具有显著优势，应被视为这些患者穿孔性和非穿孔性阑尾炎的首选术式。
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