Miyano G, Urao M, Lane Gj, Kato Y, Okazaki T, Yamataka A
Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Asian J Endosc Surg. 2011 Aug;4(3):116-9. doi: 10.1111/j.1758-5910.2011.00091.x. Epub 2011 Jun 20.
Laparoscopic appendectomy (LA) can be performed safely and effectively using endoloops (EL) or endostaples (ES). We compared EL and ES for stump closure during LA for complicated appendicitis in children.
All LA for complicated appendicitis performed between July 2005 and August 2009 were assessed prospectively. EL were used in 37 procedures and ES in 31. Apart from choice of technique which was the personal preference of the attending surgeon, all patients were managed according to the same intraoperative and postoperative protocols.
There was no significant difference between mean age at operation; gender ratio; mean preoperative and postoperative white blood cell; mean preoperative and postoperative white blood cell C-reactive protein; histopathology; mean operating time (EL: 71 minutes; ES: 64 minutes); mean hospitalization (EL: 5.3 days; ES: 5.1 days); febrile period (EL: 2.1 days; ES: 1.9 days); white blood cell normalization (EL: 2.6 days; ES: 2.4 days); and intravenous antibiotic usage (EL: 3.8 days; ES: 3.7 days). There were no intraoperative complications or ICU admissions in either group, but two EL cases required conversion to open surgery (P=NS). Incidences of intra-abdominal abscess (EL: n=1 or 2.7%; ES: n=1 or 3.2%), transient ileus (EL: n=2 or 5.4%; ES: n=2 or 6.4%), small bowel obstruction (EL: n=0; ES: n=0), and wound infection (EL: n=1 or 2.7%; ES: n=1 or 3.2 %) were not significantly different. Rate of rehospitalization for EL was 2.7% (n=1; colitis), and for ES, it was 3.2% (n=1; intra-abdominal abscess) (P=NS). Mean cost for EL was US$890, and for ES, it was US$1300.
This is the first prospective study comparing EL and ES during LA for complicated appendicitis in children. ES is more expensive, but there was no significant difference in morbidity for this technique, particularly with regard to incidence of postoperative intra-abdominal abscess.
使用内镜圈套器（EL）或内镜吻合器（ES）可安全有效地进行腹腔镜阑尾切除术（LA）。我们比较了在儿童复杂性阑尾炎的LA手术中，EL和ES用于残端闭合的情况。
对2005年7月至2009年8月期间所有因复杂性阑尾炎行LA手术的患者进行前瞻性评估。37例手术使用EL，31例使用ES。除技术选择取决于主刀医生的个人偏好外，所有患者均按照相同的术中及术后方案进行处理。
手术时的平均年龄、性别比例、术前及术后平均白细胞计数、术前及术后白细胞C反应蛋白、组织病理学、平均手术时间（EL：71分钟；ES：64分钟）、平均住院时间（EL：5.3天；ES：5.1天）、发热期（EL：2.1天；ES：1.9天）、白细胞恢复正常时间（EL：2.6天；ES：2.4天）以及静脉使用抗生素时间（EL：3.8天；ES：3.7天）之间均无显著差异。两组均无术中并发症或入住重症监护病房的情况，但有2例EL手术病例需要转为开放手术（P=无统计学意义）。腹腔内脓肿发生率（EL：n=1或2.7%；ES：n=1或3.2%）、短暂性肠梗阻发生率（EL：n=2或5.4%；ES：n=2或6.4%）、小肠梗阻发生率（EL：n=0；ES：n=0）以及伤口感染发生率（EL：n=1或2.7%；ES：n=1或3.2%）均无显著差异。EL组再住院率为2.7%（n=1；结肠炎），ES组为3.2%（n=1；腹腔内脓肿）（P=无统计学意义）。EL的平均费用为890美元，ES为1300美元。
这是第一项比较儿童复杂性阑尾炎LA手术中EL和ES的前瞻性研究。ES费用更高，但该技术在发病率方面无显著差异，尤其是术后腹腔内脓肿的发生率。
