Ramos J L, Villanueva A, Garay J, Suñol M, Villalón F, Urbistondo A, Jiménez J, Rezola E, Eizaguirre I
Servicio de Cirugía Pediátrica. Hospital Universitario Donostia.
Cir Pediatr. 2015 Jan 13;28(1):2-5.
In order to improve laparoscopic skills, appendectomy is the most common procedure because of its high frequency and low difficulty. In spite of that, during the learning curve (each surgeon´s first 35 interventions) the incidence of complications may increase, so improvement in training means a bigger risk for some patients.
We retrospectively reviewed major complications (intra-abdominal abscess, intestinal occlusion, hemorrhage) of 1,710 appendectomies performed at our service between 1997 and 2013. We divided them in three groups: open appendectomy (OA, n= 1,258), laparoscopic appendectomy during the learning curve (LDC, n= 154) and laparoscopic appendectomy after the learning curve (LAC, n= 298). In addition, we distinguish between simple appendicitis (n= 1,233) and peritonitis (n= 477).
In the OA group we detected110/1,258 major complications (8.7%), 28/154 major complications (18.2%) in the LDC group and 19/298 (6.4%) in the LAC group (p<0.05 LDC vs OA and LAC). In the simple appendicitis group, we found 13/889 major complications (1.5%) in OA, 3/115 (2.6%) in LDC group and 2/229 (0.9%) in LAC group (p= ns LDC vs OA and LAC). In the peritonitis group, 97/369 (26.3%) major complications were found in OA group, 25/39 (64%) in LDC group and 17/69 (24.6%) in LAC group (p<0.05 LDC vs OA and LAC).
Educational purpose laparoscopic appendectomy must be used in simple appendicitis cases.
为提高腹腔镜手术技能，阑尾切除术因手术频率高、难度低成为最常见的手术。尽管如此，在学习曲线阶段（每位外科医生的前35例手术）并发症发生率可能会增加，因此培训的改进对一些患者意味着更大的风险。
我们回顾性分析了1997年至2013年在我院进行的1710例阑尾切除术的主要并发症（腹腔内脓肿、肠梗阻、出血）。我们将其分为三组：开腹阑尾切除术（OA，n = 1258）、学习曲线阶段的腹腔镜阑尾切除术（LDC，n = 154）和学习曲线阶段后的腹腔镜阑尾切除术（LAC，n = 298）。此外，我们区分了单纯性阑尾炎（n = 1233）和腹膜炎（n = 477）。
OA组检测到110/1258例主要并发症（8.7%），LDC组为28/154例主要并发症（18.2%），LAC组为19/298例（6.4%）（LDC与OA和LAC相比，p<0.05）。在单纯性阑尾炎组中，OA组发现13/889例主要并发症（1.5%），LDC组为3/115例（2.6%），LAC组为2/229例（0.9%）（LDC与OA和LAC相比，p=无统计学意义）。在腹膜炎组中，OA组发现97/369例（26.3%）主要并发症，LDC组为25/39例（64%），LAC组为17/69例（24.6%）（LDC与OA和LAC相比，p<0.05）。
以教育为目的的腹腔镜阑尾切除术应仅用于单纯性阑尾炎病例中。
