Li Ping, Han Yan, Yang Yang, Guo Hongjie, Hao Fabao, Tang Yan, Guo Chunbao
Department of Ultrasound, The Affiliated Hospital of Medical College, Qingdao University, Qingdao Department of Neonatal Department of Pediatric General Surgery and Liver Transplantation Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.
Medicine (Baltimore). 2017 Jul;96(30):e7514. doi: 10.1097/MD.0000000000007514.
Laparoscopic appendectomy (LA) has become well accepted, but the role of LA for appendicitis upon presentation with an abscess remains undefined. This study was to assess the postoperative recovery and complications following LA in pediatric patients with appendiceal abscess in comparison with open appendectomy (OA).We conducted a retrospective review of patients presented with appendiceal abscess between 2005 and 2016. Propensity score matching (PSM) was conducted to adjust for any potential selection bias for the surgical approaches. In 108 matched patients, operative outcomes and surgical complications were evaluated based on LA or OA.The patients with LA experienced prompt postoperative gastrointestinal function recovery, like first bowel movement (risk ratio [RR], 0.52; 95% confidence interval [CI], 0.44-0.69; P < .001), so spend the lower mean length of hospitalization (RR, 0.53; 95% CI, 0.41-0.76; P < .001) in comparison with patients with OA. Furthermore, the immunologic and inflammatory variable white blood cell (WBC) (RR, 0.56; 95% CI, 0.46-0.73; P < .001) and C-reactive protein (CRP) (RR, 0.58; 95% CI, 0.43-0.86; P = .011) on postoperative days (POD) 5 was reduced in patients undergone LA compared with that of OA. A lower overall postoperative complication rate, including surgical wound infection (odds ratio [OR], 0.38; 95% CI, 0.18-0.81; P = .008) and incision dehiscence (OR, 0.06; 95% CI, 0.01-0.45; P < .001) was noted in patients with LA compared with OA.LA was feasible and effective for appendicitis upon presentation with an abscess and associated with beneficial clinical effects, such as postoperative gastrointestinal function recovery and reduced postoperative complications. LA should be seriously considered as the first line procedure of choice.
腹腔镜阑尾切除术（LA）已被广泛接受，但LA在阑尾脓肿患者中的作用仍不明确。本研究旨在评估小儿阑尾脓肿患者LA术后的恢复情况及并发症，并与开腹阑尾切除术（OA）进行比较。我们对2005年至2016年间出现阑尾脓肿的患者进行了回顾性研究。采用倾向评分匹配（PSM）来调整手术方式的潜在选择偏倚。在108例匹配患者中，根据LA或OA评估手术结果和手术并发症。与OA患者相比，LA患者术后胃肠功能恢复迅速，如首次排便（风险比[RR]，0.52；95%置信区间[CI]，0.44 - 0.69；P<0.001），平均住院时间也较短（RR，0.53；95%CI，0.41 - 0.76；P<0.001）。此外，LA患者术后第5天的免疫和炎症指标白细胞（WBC）（RR，0.56；95%CI，0.46 - 0.73；P<0.001）和C反应蛋白（CRP）（RR，0.58；95%CI，0.43 - 0.86；P = 0.011）较OA患者降低。与OA患者相比，LA患者术后总体并发症发生率较低，包括手术伤口感染（比值比[OR]，0.38；95%CI，0.18 - 0.81；P = 0.008）和切口裂开（OR，0.06；95%CI，0.01 - 0.45；P<0.001）。LA对于阑尾脓肿患者是可行且有效的，并且具有有益的临床效果，如术后胃肠功能恢复和术后并发症减少。LA应被认真考虑作为首选的一线手术方式。
