Cao Jianguo, Tao Feng, Xing Hao, Han Jun, Zhou Xiaojun, Chen Tinghao, Wang Hong, Li Zhizhou, Zhou Yahao, Wang Shusheng, Yang Tian
*Department of General Surgery, Zhangjiagang First People's Hospital of Suzhou †Department of General Surgery, Changshu First People's Hospital of Suzhou §Department of General Surgery, First Affiliated Hospital of Suzhou University of Suzhou, Jiangsu ‡Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai ∥Department of General Surgery, Ziyang First People's Hospital, Sichuan ¶Department of General Surgery, Liuyang People's Hospital, Hunan #Department of General Surgery, Xuancheng People's Hospital, Anhui **Department of General Surgery, Pu'er People's Hospital, Yunnan, China.
Surg Laparosc Endosc Percutan Tech. 2017 Oct;27(5):409-414. doi: 10.1097/SLE.0000000000000460.
The aim of this study was to identify independent risk factors for postoperative intra-abdominal abscess (IAA) after appendectomy for patients with acute appendicitis.
Although laparoscopic appendectomy (LA) has been performed universally, whether LA is associated with an increased incidence of postoperative IAA compared with open appendectomy (OA) remains controversial, which causes some surgeons' increasing concerns.
We retrospectively analyzed 6805 consecutive adult patients with acute appendicitis who underwent LA or OA at 7 general hospitals in China. Patient characteristics, operative variables, and surgical outcomes were collected and compared between patients who underwent LA and OA. Propensity score matching analysis was used to minimize the bias in patient selection differing from various procedure of appendectomy. Independent risk factors associated with the development of postoperative IAA after appendectomy were identified by univariate and multivariate logistic regression analysis in the propensity matched cohort.
Over a 3-year period, 2710 (39.8%) and 4095 (60.2%) patients underwent LA and OA respectively. Patients who underwent OA had more males, American Society of Anesthesiologists score 2-3, preoperative systemic inflammatory response syndrome, and perforated appendicitis than those who underwent LA (all P<0.01). Propensity score matched analysis created 2542 pairs of patients. Univariate analysis revealed that patients who underwent LA had a higher incidence of postoperative IAA than patients who underwent OA (6.7% vs. 5.3%; P=0.039). However, multivariate logistic regression analysis identified LA not to be an independent risk factor associated with the development of postoperative IAA (odds ratio, 1.053; 95% confidence interval, 0.922-1.657; P=0.216).
The present study identified that laparoscopic procedure was not an independent risk factor associated with the development of postoperative IAA after appendectomy of acute appendicitis. Therefore, concerns of increased incidence of IAA because of laparoscopic procedure are unwarranted.
本研究旨在确定急性阑尾炎患者阑尾切除术后腹腔内脓肿（IAA）的独立危险因素。
尽管腹腔镜阑尾切除术（LA）已广泛开展，但与开腹阑尾切除术（OA）相比，LA是否会增加术后IAA的发生率仍存在争议，这引起了一些外科医生越来越多的关注。
我们回顾性分析了在中国7家综合医院连续接受LA或OA的6805例成年急性阑尾炎患者。收集并比较了接受LA和OA患者的患者特征、手术变量和手术结果。采用倾向评分匹配分析以尽量减少因阑尾切除术的不同术式导致的患者选择偏差。在倾向匹配队列中，通过单因素和多因素逻辑回归分析确定与阑尾切除术后IAA发生相关的独立危险因素。
在3年期间，分别有2710例（39.8%）和4095例（60.2%）患者接受了LA和OA。接受OA的患者比接受LA的患者男性更多、美国麻醉医师协会评分2 - 3分、术前全身炎症反应综合征及阑尾穿孔的比例更高（均P<0.01）。倾向评分匹配分析产生了2542对患者。单因素分析显示，接受LA的患者术后IAA发生率高于接受OA的患者（6.7%对5.3%；P = 0.039）。然而，多因素逻辑回归分析确定LA不是与术后IAA发生相关的独立危险因素（比值比，1.053；95%置信区间，0.922 - 1.657；P = 0.216）。
本研究表明，腹腔镜手术不是急性阑尾炎阑尾切除术后IAA发生的独立危险因素。因此，因腹腔镜手术导致IAA发生率增加的担忧是没有根据的。
