Slijper Nadav, Mogilner Jorge G, Sukhotnik Igor
Harefuah. 2015 Dec;154(12):774-7, 805, 804.
Laparoscopic appendectomy (LA) is widely accepted for simple appendicitis but it is still debatable in complicated cases (gangrenous or perforated appendicitis).
The purpose of the present study was to evaluate the outcomes of LA versus open appendectomy (OA) in uncomplicated and complicated appendicitis in children.
A retrospective analysis of the clinical data of children (< 18 years old) who underwent LA and CA from 2008 to 2011 was performed. The incidental appendectomies were excluded. The patients were divided into four groups according to the severity of the disease (uncomplicated vs complicated) and by the surgical approach (LA vs OA). Data were compared with regard to demographic features, pre-operative, intra-operative and post-operative findings.
A total of 335 children underwent urgent appendectomy during this period. The overall rate of perforated appendicitis was 26.9%; 143 patients (42.7%) underwent LA and 192 patients (57.3%) underwent CA. Operative times and complication rates did not differ significantly between LA and OA in either complicated to uncomplicated appendicitis; LOS was shorter in the uncomplicated group (2.14 ± 0.17 vs 3.15 ± 0.14, p < 0.01). Two patients from the uncomplicated group underwent conversions form LA to OA (conversion rate of 1.36%) because of intraoperative bleeding, and one patient in the OA-complicated group had a cecal injury. There were no mortalities in this group.
Laparoscopic appendectomy for complicated appendicitis in children is feasible and safe, does not harbor any risks in comparison to the open traditional procedure, and allows the benefits of better view, flexible angle of approach and cosmesis.
腹腔镜阑尾切除术（LA）对于单纯性阑尾炎已被广泛接受，但在复杂病例（坏疽性或穿孔性阑尾炎）中仍存在争议。
本研究的目的是评估儿童单纯性和复杂性阑尾炎行LA与开腹阑尾切除术（OA）的疗效。
对2008年至2011年接受LA和CA的18岁以下儿童的临床资料进行回顾性分析。排除偶然阑尾切除术。根据疾病严重程度（单纯性与复杂性）和手术方式（LA与OA）将患者分为四组。比较人口统计学特征、术前、术中和术后结果的数据。
在此期间共有335名儿童接受了急诊阑尾切除术。穿孔性阑尾炎的总体发生率为26.9%；143例患者（42.7%）接受了LA，192例患者（57.3%）接受了CA。在复杂性和单纯性阑尾炎中，LA和OA的手术时间和并发症发生率无显著差异；单纯性组的住院时间较短（2.14±0.17 vs 3.15±0.14，p<0.01）。单纯性组有2例患者因术中出血从LA转为OA（转化率为1.36%），OA复杂性组有1例患者发生盲肠损伤。该组无死亡病例。
儿童复杂性阑尾炎行腹腔镜阑尾切除术是可行且安全的，与传统开腹手术相比没有任何风险，并且具有视野更好、手术入路角度灵活和美观的优点。
