Allaway Matthew G R, Eslick Guy D, Cox Michael R
Sydney Medical School, The University of Sydney, Nepean Hospital, Clinical Sciences Building, P. O. Box 67, Penrith, NSW, 2751, Australia.
The Whiteley-Martin Research Centre, Nepean Hospital, Penrith, NSW, Australia.
World J Surg. 2019 Feb;43(2):405-414. doi: 10.1007/s00268-018-4784-6.
One of the most common acute conditions managed by general surgeons is acute appendicitis. Laparoscopic appendicectomy (LA) is the surgical technique used by many surgeons. The aims of this study were to define our unit's negative appendicectomy rate and compare the outcomes associated with removal of a normal appendix with those for acute appendicitis in patients having LA.
A single-centre retrospective case note review of patients undergoing LA for suspected acute appendicitis was performed. Patients were divided into positive and negative appendicectomy groups based on histology results. The positive group was subdivided into uncomplicated and complicated (perforated and/or gangrenous) appendicitis. Outcomes were compared between groups.
There were 1413 patients who met inclusion criteria, 904 in the positive group and 509 in the negative group, an overall negative appendicectomy rate of 36.0%. Morbidity rates (6.3% vs. 6.9%; P = 0.48) and types of morbidity were the same for negative appendicectomy and uncomplicated appendicitis. There was no significant difference in complication severity (all P > 0.17) or length of stay (2.3 vs. 2.6 days; P = 0.06) between negative appendicectomy and uncomplicated appendicitis groups. Patients with complicated appendicitis had a significantly higher morbidity rate compared to negative and uncomplicated groups (20.1% vs. 6.3% and 20.1% vs. 6.9%; both P < 0.001).
The morbidity of negative LA is the same as LA for uncomplicated appendicitis. The morbidity of LA for complicated appendicitis is significantly higher. The selection criteria for LA in our unit needs to be reviewed to address the high negative appendicectomy rate and avoid unnecessary surgery and its associated morbidity.
普通外科医生处理的最常见急性病症之一是急性阑尾炎。腹腔镜阑尾切除术（LA）是许多外科医生采用的手术技术。本研究的目的是确定我们科室的阴性阑尾切除术发生率，并比较腹腔镜阑尾切除术中切除正常阑尾与急性阑尾炎患者的手术结果。
对因疑似急性阑尾炎接受腹腔镜阑尾切除术的患者进行单中心回顾性病例记录审查。根据组织学结果将患者分为阳性和阴性阑尾切除术组。阳性组再细分为单纯性和复杂性（穿孔和/或坏疽性）阑尾炎。比较各组间的手术结果。
1413例患者符合纳入标准，阳性组904例，阴性组509例，总体阴性阑尾切除术发生率为36.0%。阴性阑尾切除术和单纯性阑尾炎的发病率（6.3%对6.9%；P = 0.48）及发病类型相同。阴性阑尾切除术组与单纯性阑尾炎组在并发症严重程度（所有P > 0.17）或住院时间（2.3天对2.6天；P = 0.06）方面无显著差异。与阴性组和单纯性阑尾炎组相比，复杂性阑尾炎患者的发病率显著更高（20.1%对6.3%以及20.1%对6.9%；均P < 0.001）。
阴性腹腔镜阑尾切除术的发病率与单纯性阑尾炎的腹腔镜阑尾切除术相同。复杂性阑尾炎的腹腔镜阑尾切除术发病率显著更高。需要审查我们科室腹腔镜阑尾切除术的选择标准，以解决高阴性阑尾切除术发生率问题，并避免不必要的手术及其相关发病率。
