Department of General Surgery, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada, Osaka, 596-0042, Japan.
Eur J Trauma Emerg Surg. 2020 Aug;46(4):847-851. doi: 10.1007/s00068-019-01086-5. Epub 2019 Feb 2.
Appendectomy is one of the most common operations. Laparoscopic appendectomy (LA) is considered first-line treatment, but the use of LA for treatment of complicated appendicitis remains controversial. Here, we performed a retrospective analysis to compare clinical outcomes between patients treated with LA and those who underwent open appendectomy (OA).
Data for 179 patients who underwent an operation for the treatment of complicated appendicitis at our hospital between 2011 and 2017 were retrospectively analyzed. The selection included 89 patients who underwent a conventional appendectomy and 90 patients who were treated laparoscopically. Outcome measures such as mean operative time, blood loss, time until oral intake duration of hospital stay, and postoperative complications were analyzed. Logistic regression analysis was performed to determine the concurrent effects of the examined factors on the rate of postoperative complications.
The mean ages of patients in the OA and LA groups were 50.17 ± 22.77 and 50.13 ± 25.84 year. Mean operative times were longer in the LA group than OA (10.2.56 ± 44.4 versus 85.4 ± 43.11 min; p = 0.009). The duration of hospital stay was shorter for the LA group (9.61 ± 5.57 versus 12.19 ± 8.4; p = 0.016). There were no significant differences in return to consumption of oral intake between the LA and OA groups (2.03 ± 1.66 versus 2.48 ± 2.17; p = 0.123). Multivariable analysis found that the rate of postoperative complications was significantly reduced for the LA group, in comparison with the postoperative-complication rate of the OA group (16.7% versus 27%; odds ratio 0.376; 95% CI 0.153-0.923; p = 0.0327).
These results suggest that LA is a safe and efficient operative procedure that provides clinically beneficial advantages in comparison with OA. Thus, when possible, appendectomy for complicated appendicitis should be attempted using a laparoscopic approach.
Retrospectively registered.
阑尾切除术是最常见的手术之一。腹腔镜阑尾切除术（LA）被认为是一线治疗方法，但 LA 治疗复杂性阑尾炎的应用仍存在争议。在这里，我们进行了一项回顾性分析，比较了接受 LA 治疗和接受开腹阑尾切除术（OA）治疗的患者的临床结果。
回顾性分析了 2011 年至 2017 年期间在我院接受手术治疗复杂性阑尾炎的 179 例患者的数据。入选标准包括 89 例行传统阑尾切除术和 90 例行腹腔镜治疗的患者。分析了手术时间、出血量、开始口服摄入时间、住院时间和术后并发症等结果。采用 logistic 回归分析确定检查因素对术后并发症发生率的并发影响。
OA 组和 LA 组患者的平均年龄分别为 50.17±22.77 岁和 50.13±25.84 岁。LA 组的手术时间明显长于 OA 组（10.2.56±44.4 分钟比 85.4±43.11 分钟；p=0.009）。LA 组的住院时间较短（9.61±5.57 天比 12.19±8.4 天；p=0.016）。LA 组和 OA 组患者开始口服摄入的时间无显著差异（2.03±1.66 分钟比 2.48±2.17 分钟；p=0.123）。多变量分析发现，LA 组术后并发症发生率明显低于 OA 组（16.7%比 27%；比值比 0.376；95%置信区间 0.153-0.923；p=0.0327）。
这些结果表明，LA 是一种安全有效的手术方法，与 OA 相比具有临床有益优势。因此，在可能的情况下，应尝试采用腹腔镜方法治疗复杂性阑尾炎。
回顾性注册。
