Department of General Surgery, Tongji Hospital, Tongji University, 389 XinCun Road, Shanghai 200065, PR China.
World J Emerg Surg. 2014 Jan 8;9(1):3. doi: 10.1186/1749-7922-9-3.
The purpose of this study was to compare the clinical outcomes and cost effectiveness of the gasless laparoscopic appendectomy (GLA) and conventional laparoscopic appendectomy (LA).
From Aug 2010 to Feb 2012, 100 patients with a clinical diagnosis of acute appendicitis in Shanghai Tongji hospital were included in the study and randomly divided into the LA and GLA groups, fifty in the GLA group and 50 in the LA group. The two groups were comparable in age, gender, body mass index, symptom duration, ASA score, and white blood cell count.
The mean surgical duration was 70.6 ± 30.8 min in the GLA group and 62.6 ± 22.0 min in the LA group (P = 0.138). The total conversion rate was 8% in the GLA group, while no conversions occurred in the LA group. Postoperative complications did not significantly differ between the two groups. Fentanyl consumption was decreased significantly in the GLA group (P = 0.019) postoperatively. The length of the total hospital stay was 4.36 ± 1.74 days in the GLA group compared with 5.68 ± 4.44 days in the LA group (P = 0.053). There was a significant decrease in the total hospital cost when the GLA group was compared with the LA group (6659 ± 1782 vs. 9056 ± 2680 Yuan, respectively, P < 0.001).
GLA and conventional LA are comparable in terms of operative duration, complications, and total hospital stay. The obvious advantage of GLA is the significantly reduced hospital cost. The demand for postoperative analgesics may also decrease following GLA. In conclusion, GLA is a safe and feasible procedure in selected patients.
Chinese Clinical Trial Register ChiCTR-TRC-10001203.
本研究旨在比较无气腹腔镜阑尾切除术（GLA）和传统腹腔镜阑尾切除术（LA）的临床效果和成本效益。
2010 年 8 月至 2012 年 2 月，上海同济大学医院收治的 100 例临床诊断为急性阑尾炎的患者被纳入本研究，并随机分为 LA 组和 GLA 组，每组 50 例。两组患者在年龄、性别、体重指数、症状持续时间、ASA 评分和白细胞计数方面具有可比性。
GLA 组的平均手术时间为 70.6±30.8 分钟，LA 组为 62.6±22.0 分钟（P=0.138）。GLA 组总转化率为 8%，LA 组无转化率。两组术后并发症无显著差异。GLA 组术后芬太尼消耗量明显减少（P=0.019）。GLA 组总住院时间为 4.36±1.74 天，LA 组为 5.68±4.44 天（P=0.053）。与 LA 组相比，GLA 组的总住院费用明显降低（6659±1782 与 9056±2680 元，P<0.001）。
GLA 和传统 LA 在手术时间、并发症和总住院时间方面无差异。GLA 的明显优势是显著降低了住院费用。GLA 术后对镇痛药的需求也可能减少。总之，GLA 在选择的患者中是一种安全可行的方法。
中国临床试验注册中心 ChiCTR-TRC-10001203。
