Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University & Jiangsu Province Hospital, Guangzhou Road, 300, Gulou District, Nanjing, 210029, Jiangsu, People's Republic of China.
Division of Gastric Surgery, The First Affiliated Hospital of Nanjing Medical University & Jiangsu Province Hospital, Guangzhou Road, 300, Gulou District, Nanjing, 210029, Jiangsu, People's Republic of China.
Surg Endosc. 2020 Feb;34(2):779-786. doi: 10.1007/s00464-019-06828-5. Epub 2019 May 13.
The aim of this study was to compare the outcomes of laparoscopic appendectomy (LA) using purse string invaginating sutures (PS) with those using intracorporeal knotting (IK) or Hem-o-lock polymeric clips (HL).
A total of 882 patients who underwent laparoscopic appendectomy from January 2015 to December 2017 were studied retrospectively. Of these, 538 patients used PS, 229 patients used IK and 115 patients used HL to close the appendiceal stump. Their demographic characteristics, intraoperative findings and postoperative complications were analysed retrospectively.
There were similar percentages of complicated cases in all the groups (21.7% in PS vs. 21.4% in IK vs. 24.3% in HL, p = 0.803). The mean length of hospital stay was shorter in PS group when compared to IK or HL group (3.72 + 2.35 in PS vs. 4.41 + 2.40 in IK, 4.43 + 2.66 in HL, p < 0.05) as well as lower ASA scores (1.7 + 0.6 in PS vs. 1.8 + 0.6 in IK vs. 1.7 + 0.6 in HL, p < 0.05). The overall complication rates for the PS, the HL and the IK groups were 12.1, 8.7 and 9.2%, respectively. The rate of wound infection was higher in PS group for uncomplicated appendicitis (5.0% in PS vs. 2.8% in IK and 1.1% in HL, p = 0.129). Furthermore, there were no differences in the rate of intra-abdominal infection among the groups in both uncomplicated and complicated cases.
Based on our results, purse string suture failed to demonstrate better postoperative outcome in laparoscopic appendectomy and is no longer recommended by our institution as initial approach.
本研究旨在比较使用荷包缝合线（PS）、腔内线结（IK）和 Hem-o-lock 聚合物夹（HL）闭合阑尾残端的腹腔镜阑尾切除术（LA）的结果。
回顾性分析 2015 年 1 月至 2017 年 12 月期间接受腹腔镜阑尾切除术的 882 例患者的临床资料。其中 538 例采用 PS，229 例采用 IK，115 例采用 HL。分析比较三组患者的一般资料、术中发现及术后并发症。
三组复杂病例的比例相似（PS 组为 21.7%，IK 组为 21.4%，HL 组为 24.3%，p=0.803）。PS 组的住院时间明显短于 IK 组或 HL 组（PS 组为 3.72±2.35，IK 组为 4.41±2.40，HL 组为 4.43±2.66，p<0.05），ASA 评分也较低（PS 组为 1.7±0.6，IK 组为 1.8±0.6，HL 组为 1.7±0.6，p<0.05）。PS 组、HL 组和 IK 组的总体并发症发生率分别为 12.1%、8.7%和 9.2%。PS 组单纯性阑尾炎的切口感染率较高（PS 组为 5.0%，IK 组为 2.8%，HL 组为 1.1%，p=0.129）。此外，在单纯性和复杂性病例中，三组的腹腔内感染发生率均无差异。
根据我们的结果，荷包缝合线在腹腔镜阑尾切除术中并未显示出更好的术后效果，因此我们医院不再推荐将其作为初始方法。
