Department of Surgery, Children's Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
J Pediatr Surg. 2012 Dec;47(12):2264-7. doi: 10.1016/j.jpedsurg.2012.09.019.
BACKGROUND/PURPOSE: Appendicitis is one of the most common surgical conditions in children. Laparoscopy has become the standard approach to appendectomy over the past decade. Some critics cite a lack of evidence documenting clear advantages to laparoscopy. To define the pattern of approach compared to outcomes in the United States, we analyzed the Pediatric Health Information System (PHIS) database to document the impact on outcomes with the rise in laparoscopy.
After IRB approval, we queried the PHIS database for all patients over 12 years. The percentages of cases performed open (OA) and laparoscopically (LA) were established for each year. Annual complication percentages were identified for wound infection, intra-abdominal abscess, subsequent laparotomy, and obstruction. For each complication, trend comparisons between LA and OA were made with generalized linear models.
There were 111,194 appendectomies with a positive trend in percentage of laparoscopy from 1999 (22.2%) to 2010 (90.8%), P<0.0001. Over 12 years, there were significant differential trends between LA and OA in rates of wound infection, abscesses, bowel obstructions, and laparotomies within 30 days (P<0.0001 for each). There was no trend in wound infection rates within OA over time (P=0.31), while there was a decrease in infection rates within LA over time (P<0.0001).
On the basis of a national database analysis, laparoscopy has increased for appendectomy in children over the past 12 years and is associated with a significant decrease in post-operative complications.
背景/目的：阑尾炎是儿童最常见的外科病症之一。在过去十年中，腹腔镜已成为阑尾切除术的标准方法。一些批评者认为，缺乏证据证明腹腔镜具有明显优势。为了确定与美国相比的手术方法模式及其对结果的影响，我们分析了儿科健康信息系统（PHIS）数据库，以记录腹腔镜手术增加对结果的影响。
获得机构审查委员会批准后，我们在 PHIS 数据库中查询了所有 12 岁以上的患者。确定了每年开放手术（OA）和腹腔镜手术（LA）的病例比例。确定了伤口感染、腹腔脓肿、后续剖腹手术和肠梗阻的每年并发症比例。对于每种并发症，使用广义线性模型比较 LA 和 OA 之间的趋势比较。
有 111194 例阑尾切除术，腹腔镜手术的百分比呈阳性趋势，从 1999 年（22.2%）到 2010 年（90.8%），P<0.0001。在 12 年内，LA 和 OA 在 30 天内的伤口感染、脓肿、肠梗阻和剖腹手术的发生率之间存在显著的差异趋势（P<0.0001）。OA 中伤口感染率随时间无趋势（P=0.31），而 LA 中感染率随时间下降（P<0.0001）。
基于全国数据库分析，过去 12 年来，儿童阑尾切除术的腹腔镜手术有所增加，与术后并发症显著减少相关。
