Varlet F, Tardieu D, Limonne B, Metafiot H, Chavrier Y
Service de Chirurgie Pédiatrique, Hôpital Nord, CHRU de Saint Etienne, France.
Eur J Pediatr Surg. 1994 Dec;4(6):333-7. doi: 10.1055/s-2008-1066128.
Laparoscopic appendectomy (LA) has not achieved widespread acceptance among surgeons, open appendectomy (OA) being a simple and secure technique. We compared retrospectively 200 LAs and 203 OAs in children and adolescents (mean age = 10 years) from January 1, 1989, to March 31, 1993. The introduction of LA did not modify our operative indications. Laparoscopic investigations found 22 right lower quadrant peritoneal adhesion diseases (11%), those lesions were totally unknown with OA. Operative complications are more frequent with LA (5% versus 1%--p < 0.02): bleeding of the appendiculary artery or of an epigastric vessel, intestinal perforation and burn of the ileum are the most serious complications that we had. On the other hand, the postoperative complications mostly occur after OAs (10.8% versus 1.5%--p < 0.001): 11 wound abscesses, 8 intraperitoneal infections and 4 obstructions after OA and only 1 wound abscess and 2 intra peritoneal abscesses after LA. The general anesthesia was significantly longer for LA (72 minutes vs 55 minutes--p < 0.001). Mean hospital stay was 4 days after LA and 6.4 days after OA. The postoperative complications involved 27 additional hospital days after LA and 162 days for OA. As a conclusion, OA is quicker and has few operative complications. But LA has many advantages: less traumatic, easy treatment of ectopic appendix, efficient lavage of the peritoneum, less frequent postoperative complications and better postoperative comfort. All this encourages us to go on with LA, all the more as the operative complications fall off with the training of the operator.
腹腔镜阑尾切除术（LA）在外科医生中尚未得到广泛认可，开腹阑尾切除术（OA）是一种简单且安全的技术。我们回顾性比较了1989年1月1日至1993年3月31日期间200例儿童和青少年（平均年龄10岁）的LA手术和203例OA手术。LA的引入并未改变我们的手术适应症。腹腔镜检查发现22例右下腹腹膜粘连疾病（11%），而这些病变在OA手术中完全未被发现。LA手术的并发症更为常见（5% 对1%，p < 0.02）：阑尾动脉或腹壁血管出血、肠穿孔和回肠灼伤是我们遇到的最严重并发症。另一方面，术后并发症大多发生在OA手术后（10.8% 对1.5%，p < 0.001）：OA手术后有11例伤口脓肿、8例腹腔内感染和4例肠梗阻，而LA手术后仅有1例伤口脓肿和2例腹腔内脓肿。LA手术的全身麻醉时间明显更长（72分钟对55分钟，p < 0.001）。LA术后平均住院天数为4天，OA术后为6.4天。术后并发症导致LA术后额外住院27天，OA术后额外住院162天。总之，OA手术更快且手术并发症少。但LA有许多优点：创伤小、易于处理异位阑尾、能有效冲洗腹膜、术后并发症较少且术后舒适度更高。所有这些都鼓励我们继续开展LA手术，尤其是随着术者经验的积累手术并发症会减少。
