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阑尾系膜解剖的腹腔镜阑尾切除术治疗急性阑尾炎的疗效及影响因素

Therapeutic effectiveness and influencing factors of laparoscopic appendectomy with mesoappendix dissection in the treatment of acute appendicitis.

作者信息

Yuan Jiang, Liu Qiang, Wu Bo-Yu

机构信息

Department of General Surgery, Shangrao Municipal Hospital, Shangrao 334000, Jiangxi Province, China.

出版信息

World J Gastrointest Surg. 2025 Mar 27;17(3):103516. doi: 10.4240/wjgs.v17.i3.103516.

Abstract

BACKGROUND

Acute appendicitis (AP) is a frequently encountered surgical emergency, and appendectomy is conventionally regarded as the predominant treatment modality. Nevertheless, the therapeutic efficacy of this surgical approach remains to be improved. Thus, the exploration and implementation of surgical refinements are necessary.

AIM

To elucidate the therapeutic effectiveness and influencing factors of laparoscopic appendectomy (LA) with mesoappendix dissection in the treatment of AP.

METHODS

First, 150 patients with AP who visited Shangrao Municipal Hospital between January 2022 and June 2024 were enrolled in this study. Among them, 72 patients were assigned to the control group to receive conventional LA, whereas 78 cases were included in the observation group for LA with mesoappendix dissection. Subsequently, indicators such as therapeutic effectiveness, surgical indices (operation time, intraoperative blood loss, and hospital stay), postoperative recovery indices (time to ambulation, gastrointestinal function recovery time, and time to food intake), incidence of adverse events (postoperative bleeding, pelvic infection, puncture site infection, and ileus), and serum inflammatory factors [tumor necrosis factor (TNF)-α, interleukin (IL)-6, and C-reactive protein (CRP)] were collected and comparatively analyzed, and the influencing factors of therapeutic effectiveness in patients with AP were analyzed.

RESULTS

Compared with the control group, the observation group had higher clinical therapeutic effectiveness, less operation time, intraoperative blood loss, and hospital stay; shorter time to ambulation, gastrointestinal function recovery, and food intake; and a lower total incidence of adverse events, and this difference is statistically significant. In addition, the expression levels of various serum inflammatory factors in the observation group were significantly reduced postoperatively, which were markedly lower than those in the control group. Moreover, sex, age, body mass index, time from acute onset to admission, family medical history, preoperative TNF-α, preoperative IL-6, preoperative CRP, and treatment modality were identified to be not independent factors affecting the therapeutic effectiveness of LA with mesoappendix dissection in patients with AP.

CONCLUSION

Overall, LA with mesoappendix dissection has a remarkable curative effect in treating patients with AP, which is worthy of clinical promotion.

摘要

背景

急性阑尾炎(AP)是一种常见的外科急症,传统上阑尾切除术被视为主要的治疗方式。然而,这种手术方法的治疗效果仍有待提高。因此,探索和实施手术改进是必要的。

目的

阐明阑尾系膜解剖的腹腔镜阑尾切除术(LA)治疗AP的疗效及影响因素。

方法

首先,选取2022年1月至2024年6月期间在上饶市立医院就诊的150例AP患者纳入本研究。其中,72例患者被分配至对照组接受传统LA,而78例患者被纳入观察组接受阑尾系膜解剖的LA。随后,收集并比较分析治疗效果、手术指标(手术时间、术中出血量和住院时间)、术后恢复指标(下床活动时间、胃肠功能恢复时间和进食时间)、不良事件发生率(术后出血、盆腔感染、穿刺部位感染和肠梗阻)以及血清炎症因子[肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6和C反应蛋白(CRP)],并分析AP患者治疗效果的影响因素。

结果

与对照组相比,观察组临床治疗效果更高,手术时间、术中出血量和住院时间更少;下床活动、胃肠功能恢复和进食时间更短;不良事件总发生率更低,且差异具有统计学意义。此外,观察组术后各种血清炎症因子的表达水平显著降低,明显低于对照组。而且,性别、年龄、体重指数、急性发病至入院时间、家族病史、术前TNF-α、术前IL-6、术前CRP和治疗方式被确定为不影响阑尾系膜解剖的LA治疗AP患者疗效的独立因素。

结论

总体而言,阑尾系膜解剖的LA治疗AP患者具有显著疗效,值得临床推广。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd88/11948131/20379d7783fe/103516-g001.jpg

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