急性阑尾炎外科治疗的进展：单中心经验。
Development in the surgical treatment of acute appendicitis: A single-center experience.
机构信息
Department of Medical and Sugical Science, Pediatric Surgical Unit, Azienda Ospedaliera-Universitaria "Ospedali Riuniti Foggia", University of Foggia, Foggia, Italy.
出版信息
Afr J Paediatr Surg. 2020 Jan-Jun;17(1-2):5-9. doi: 10.4103/ajps.AJPS_77_17.
PURPOSE
Laparoscopy has become the treatment of choice for acute appendicitis. The aim of the study was to compare open (OA) and laparoscopic (LA) approaches in all forms of acute appendicitis.
METHODOLOGY
Two hundred and ninety-two children underwent appendectomy (238 LA/54 OA). 3/238 patients required conversion. LA surgical technique has been modified by closing also the distal stump of appendix (DSC) before removing it.
RESULTS
Early experience: 130 appendectomy, 44 by OA (34%), and 86 by LA (66%). The mean operative time was similar for both techniques. Complicated appendicitis (CA) was observed in 14 patients (11%). 10 patients treated with OA (10/14 = 71%) and 4 with LA (4/14 = 29%). Complications occurred mainly in the LA group without statistical significance.
LATE EXPERIENCE
One hundred and sixty-two appendectomy, 10 OA (6.17%), and 152 LA (93.8%). Thirty-eight children (23.4%) had CA. The mean operative time was lower in LA group without reaching statistical significance. Total complication rate (CR) was 7.4%. CR in patients with DSC was null and significantly lower when compared to patients without DSC.
CONCLUSION
Our results demonstrated that nearly all cases of appendicitis may be managed by laparoscopy. Ligature of distal appendiceal stump is a trick that may significantly improve outcomes during LA appendectomy.
目的
腹腔镜已成为治疗急性阑尾炎的首选方法。本研究旨在比较急性阑尾炎的开腹（OA）和腹腔镜（LA）两种方法。
方法
292 例儿童接受阑尾切除术（238 例 LA/54 例 OA）。3/238 例患者需要转换。LA 手术技术通过在切除阑尾远端残端（DSC）之前关闭它进行了改进。
结果
早期经验：130 例阑尾切除术，44 例 OA（34%），86 例 LA（66%）。两种技术的平均手术时间相似。观察到 14 例复杂阑尾炎（CA）（11%）。10 例 OA 治疗（10/14=71%），4 例 LA（4/14=29%）。并发症主要发生在 LA 组，但无统计学意义。
晚期经验
162 例阑尾切除术，10 例 OA（6.17%），152 例 LA（93.8%）。38 例儿童（23.4%）患有 CA。LA 组的平均手术时间较低，但无统计学意义。总并发症发生率（CR）为 7.4%。在有 DSC 的患者中，CR 为零，与没有 DSC 的患者相比显著降低。
结论
我们的结果表明，几乎所有类型的阑尾炎都可以通过腹腔镜治疗。结扎阑尾远端残端是一种技巧，可以显著改善 LA 阑尾切除术中的结果。
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