Fukuhara Sotaro, Yano Takuya, Yoshimitsu Masanori, Oshita Ko, Katsura Yuki, Ishida Michihiro, Satoh Daisuke, Choda Yasuhiro, Nakano Kanyu, Shirakawa Yasuhiro, Matsukawa Hiroyoshi, Idani Hitoshi, Shiozaki Shigehiro, Okajima Masazumi
Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Asian J Endosc Surg. 2023 Apr;16(2):181-188. doi: 10.1111/ases.13130. Epub 2022 Sep 27.
Although some studies have reported on the relationship between appendiceal stump closure methods and postoperative complications, there is no fixed method for this procedure. This study aimed to compare treatment outcomes of the existing procedures.
We retrospectively analyzed the records of 200 patients who underwent urgent laparoscopic surgeries and investigated whether the difference in the appendiceal stump closure method was a risk factor for surgical site infection. The patients were divided into the Endoloop and endostapler groups, and 45 propensity score-matched patients were included. The treatment outcomes of the two groups were compared.
The patients with high body temperature showed significantly developed surgical site infection in multivariate analysis (P = .036). There was no significant difference in the appendix stump methods (Endoloop vs endostapler). Regarding postoperative complications, superficial and deep incisional surgical site infection, organ/space surgical site infection, ileus, and complications of Clavien-Dindo grade IIIa or higher; there was no significant difference between the endoloop and endostapler groups after propensity score matching (P = .725, 1.000, .645 and .557, respectively).
By properly using the Endoloop and endostapler according to the severity of inflammation, the Endoloop can be safely performed in many cases. Inexpensive Endoloop as an option for stump closure methods should positively impact medical costs.
尽管一些研究报道了阑尾残端闭合方法与术后并发症之间的关系，但该手术尚无固定方法。本研究旨在比较现有手术方法的治疗效果。
我们回顾性分析了200例行急诊腹腔镜手术患者的记录，调查阑尾残端闭合方法的差异是否为手术部位感染的危险因素。将患者分为Endoloop组和内镜吻合器组，纳入45例倾向评分匹配的患者。比较两组的治疗效果。
在多因素分析中，体温高的患者手术部位感染明显加重（P = 0.036）。阑尾残端方法（Endoloop与内镜吻合器）无显著差异。关于术后并发症，包括表浅和深部切口手术部位感染、器官/腔隙手术部位感染、肠梗阻以及Clavien-Dindo IIIa级或更高等级的并发症；倾向评分匹配后，Endoloop组和内镜吻合器组之间无显著差异（分别为P = 0.725、1.000、0.645和0.557）。
根据炎症的严重程度适当使用Endoloop和内镜吻合器，在许多情况下可以安全地进行Endoloop操作。作为残端闭合方法的一种选择，价格低廉的Endoloop应能对医疗成本产生积极影响。
