Lejus C, Delile L, Plattner V, Baron M, Guillou S, Héloury Y, Souron R
Service d'Anesthésie et de Reanimation Chirurgicale, Bloc opératorie de Chirurgie Pédiatrique, Nantes, France.
Anesthesiology. 1996 Apr;84(4):801-6. doi: 10.1097/00000542-199604000-00006.
The benefit of laparoscopy to patients has been clearly established in adults undergoing cholecystectomy. Results are less clear for appendectomy. The current study was undertaken to compare the respective 3-day postoperative periods after laparoscopic and open appendectomy in children.
Sixty-three children (aged 8-15 yr) scheduled for appendectomy were randomly assigned to two groups: open and laparoscopic. Postoperative evaluation included delay of postoperative recovery (walking and feeding), pain assessment by visual analog scale during the 3 subsequent days, amount of nalbuphine administered via a patient-controlled analgesia system during the first 48 h and responses by children, parents, and nurses on the overall quality of analgesia.
There was no difference between groups for demographic data (particularly macroscopic aspect of appendix) analgesia, sedation, delay before eating and walking, incidence of urinary retention, nausea, vomiting. Operative time was long (P < or = to 0.05) in the laparoscopic group (54 +/- 17 min) than in the open group (39 +/- 18 min). Thirty five percent of the children had pain at the shoulder in the LAP group versus ten percent in the open group (P < or = 0.05).
Laparoscopy did not improve analgesia and postoperative recovery after appendectomy in children.
腹腔镜手术对接受胆囊切除术的成年人的益处已得到明确证实。而对于阑尾切除术，结果尚不太明确。本研究旨在比较儿童腹腔镜阑尾切除术和开放阑尾切除术后各自的术后3天情况。
计划进行阑尾切除术的63名儿童（8 - 15岁）被随机分为两组：开放手术组和腹腔镜手术组。术后评估包括术后恢复延迟情况（行走和进食）、术后3天内通过视觉模拟量表进行的疼痛评估、前48小时通过患者自控镇痛系统给予的纳布啡剂量以及儿童、家长和护士对整体镇痛质量的反应。
两组在人口统计学数据（特别是阑尾的宏观外观）、镇痛、镇静、进食和行走前的延迟、尿潴留发生率、恶心、呕吐方面无差异。腹腔镜组的手术时间较长（P≤0.05）（54±17分钟），而开放组为（39±18分钟）。腹腔镜组35%的儿童肩部疼痛，而开放组为10%（P≤0.05）。
腹腔镜手术并未改善儿童阑尾切除术后的镇痛和术后恢复情况。
