Groves Leslie B, Ladd Mitchell R, Gallaher Jared R, Swanson John, Becher Robert D, Pranikoff Thomas, Neff Lucas P
Department of Surgery, Section of Pediatric Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Am Surg. 2013 Sep;79(9):861-4.
Although laparoscopic appendectomy (LA) is accepted treatment for perforated appendicitis (PA) in children, concerns remain whether it has equivalent outcomes with open appendectomy (OA) and increased cost. A retrospective review was conducted of patients younger than age 17 years treated for PA over a 12.5-year period at a tertiary medical center. Patient characteristics, preoperative indices, and postoperative outcomes were analyzed for patients undergoing LA and OA. Of 289 patients meeting inclusion criteria, 86 had LA (29.8%) and 203 OA (70.2%), the two groups having equivalent patient demographics and preoperative indices. Inpatient costs were not significantly different between LA and OA. LA had a lower rate of wound infection (1.2 vs. 8.9%, P = 0.017), total parenteral nutrition use (23.3 vs. 50.7%, P < 0.0001), and length of stay (5.56 ± 2.38 days vs. 7.25 ± 3.77 days, P = 0.0001). There was no significant difference in the rate of postoperative organ space abscess, surgical re-exploration, or rehospitalization. In children with PA, LA had fewer surgical site infections and shorter lengths of hospital stay compared with OA without an increase in inpatient costs.
尽管腹腔镜阑尾切除术（LA）是儿童穿孔性阑尾炎（PA）的公认治疗方法，但对于其与开腹阑尾切除术（OA）的疗效是否相当以及成本是否增加仍存在担忧。对一家三级医疗中心在12.5年期间治疗的17岁以下PA患者进行了回顾性研究。分析了接受LA和OA治疗的患者的特征、术前指标和术后结果。在289例符合纳入标准的患者中，86例行LA（29.8%），203例行OA（70.2%），两组患者的人口统计学特征和术前指标相当。LA和OA的住院费用无显著差异。LA的伤口感染率较低（1.2%对8.9%，P = 0.017），全胃肠外营养使用率较低（23.3%对50.7%，P < 0.0001），住院时间较短（5.56±2.38天对7.25±3.77天，P = 0.0001）。术后器官间隙脓肿、再次手术探查或再次住院率无显著差异。对于PA患儿，与OA相比，LA的手术部位感染较少，住院时间较短，且住院费用未增加。
