Buckley R C, Hall T J, Muakkassa F F, Anglin B, Rhodes R S, Scott-Conner C E
Department of Surgery, University of Mississippi Medical Center, Jackson 39216.
Am Surg. 1994 Jan;60(1):30-4.
Data on all laparoscopic appendectomies (LA) were collected prospectively from June 1990 through July 1992 and compared retrospectively with all open appendectomies (OA) done at the same hospital during the same time period. Laparoscopic appendectomies were performed in 29 patients (ages 15-47, mean 25.3 years) and OA in 77 patients (ages 18-71, mean 31.9 years, P < 0.01). Preoperative findings were similar in the two groups. Acute appendicitis was confirmed in 22 (76%) LA and in 57 (74%) OA; of these, 9/22 (41%) LA and 23/57 (40%) OA were gangrenous or perforated. A normal appendix was removed in seven (24%) LA and in 20 (26%) OA. Three patients (10%) required conversion of LA to an open procedure. Operative time was significantly longer for LA (mean 105 minutes) compared with OA (mean 69 minutes; P < 0.001). Postoperative complications requiring further intervention (wound infection or intraabdominal abscess) occurred in three LA (10%) and in 23 OA (30%, P < 0.05). Wound morbidity as measured by number of wounds left open at surgery or opened for infection was significantly less after LA (14% LA, 39% OA, P < 0.001). Hospital stay was significantly shorter after LA (mean 4.2 days) compared with OA (mean 6.3 days; P < 0.05). Hospital charges and professional fees were not significantly different between the two groups. In selected patients, LA is a safe, effective alternative to OA, with fewer complications and shorter hospital stay. In addition, hospital charges are similar, making an investment of more time in the operating yield an outcome equal or superior to OA.
1990年6月至1992年7月期间前瞻性收集了所有腹腔镜阑尾切除术（LA）的数据，并与同期在同一家医院进行的所有开腹阑尾切除术（OA）进行回顾性比较。29例患者接受了腹腔镜阑尾切除术（年龄15 - 47岁，平均25.3岁），77例患者接受了开腹阑尾切除术（年龄18 - 71岁，平均31.9岁，P < 0.01）。两组术前检查结果相似。22例（76%）腹腔镜阑尾切除术患者和57例（74%）开腹阑尾切除术患者确诊为急性阑尾炎；其中，9/22（41%）腹腔镜阑尾切除术患者和23/57（40%）开腹阑尾切除术患者阑尾坏疽或穿孔。7例（24%）腹腔镜阑尾切除术患者和20例（26%）开腹阑尾切除术患者切除的阑尾正常。3例（10%）患者需要将腹腔镜阑尾切除术转为开腹手术。与开腹阑尾切除术（平均69分钟；P < 0.001）相比，腹腔镜阑尾切除术的手术时间明显更长（平均105分钟）。需要进一步干预的术后并发症（伤口感染或腹腔内脓肿）在3例腹腔镜阑尾切除术患者中发生（10%），在23例开腹阑尾切除术患者中发生（30%，P < 0.05）。以手术时未缝合或因感染而打开的伤口数量衡量的伤口发病率在腹腔镜阑尾切除术后明显更低（腹腔镜阑尾切除术为14%，开腹阑尾切除术为39%，P < 0.001）。与开腹阑尾切除术（平均6.3天；P < 0.05）相比，腹腔镜阑尾切除术后住院时间明显更短（平均4.2天）。两组之间的住院费用和专业费用没有显著差异。对于选定的患者，腹腔镜阑尾切除术是开腹阑尾切除术的一种安全、有效的替代方法，并发症更少，住院时间更短。此外，住院费用相似，在手术中投入更多时间能产生与开腹阑尾切除术相当或更好的结果。
