Vallina V L, Velasco J M, McCulloch C S
Department of Surgery, Rush North Shore Medical Center, Rush Presbyterian St. Luke's Medical Center/Rush Medical College, Skokie, Illinois.
Ann Surg. 1993 Nov;218(5):685-92. doi: 10.1097/00000658-199321850-00016.
The goal of this study was to prospectively define the impact of laparoscopy on the management of patients with a presumed diagnosis of appendicitis.
While the role of laparoscopy in the management of cholelithiasis is well established, its impact on the management of acute appendicitis needs to be objectively defined and compared to that of conventional management. Several authors have predicted that laparoscopic appendectomy will become the preferred treatment for appendicitis.
Two groups of consecutive patients with similar clinical characteristics of acute appendicitis were compared. Data on the laparoscopic group were compiled prospectively on standardized forms; data on the conventional group were collected retrospectively. Operative time, hospital stay, analgesia, cost, and return to normal activities were noted.
Seventeen consecutive patients who underwent appendectomy were compared to 18 consecutive patients who underwent laparoscopy (16 of these 18 had laparoscopic appendectomy). There was no significant difference between the two groups in terms of clinical characteristics and appendiceal histopathology. The mean operative times were 61 +/- 4.1 minutes and 46 +/- 2.9 minutes for the laparoscopy and conventional groups, respectively (p < 0.01). Hospital stay was significantly shorter in the laparoscopic appendectomy group, with 81% of patients being discharged on their first postoperative day (p < 0.001). The laparoscopic appendectomy patients required significantly less narcotic analgesia (p < 0.02). Return to normal activity was not significantly different between the two groups. The average total cost of laparoscopic appendectomy was 30% greater than that of conventional appendectomy.
Laparoscopy is a useful adjunct to the management of patients with a presumed clinical diagnosis of acute appendicitis.
本研究的目的是前瞻性地确定腹腔镜检查对疑似阑尾炎患者治疗的影响。
虽然腹腔镜检查在胆结石治疗中的作用已得到充分确立，但其对急性阑尾炎治疗的影响需要客观界定，并与传统治疗方法进行比较。几位作者预测，腹腔镜阑尾切除术将成为阑尾炎的首选治疗方法。
比较两组具有相似急性阑尾炎临床特征的连续患者。腹腔镜组的数据前瞻性地记录在标准化表格上；传统组的数据则进行回顾性收集。记录手术时间、住院时间、镇痛情况、费用以及恢复正常活动的情况。
将连续17例行阑尾切除术的患者与连续18例行腹腔镜检查的患者（这18例中有16例行腹腔镜阑尾切除术）进行比较。两组在临床特征和阑尾组织病理学方面无显著差异。腹腔镜组和传统组的平均手术时间分别为61±4.1分钟和46±2.9分钟（p<0.01）。腹腔镜阑尾切除术组的住院时间明显缩短，81%的患者在术后第一天出院（p<0.001）。腹腔镜阑尾切除术患者所需的麻醉镇痛药物明显较少（p<0.02）。两组恢复正常活动的情况无显著差异。腹腔镜阑尾切除术的平均总费用比传统阑尾切除术高30%。
腹腔镜检查是疑似临床诊断为急性阑尾炎患者治疗的有用辅助手段。
