Tang E, Ortega A E, Anthone G J, Beart R W
Department of Surgery, University of Southern California School of Medicine, Los Angeles 90033, USA.
Surg Endosc. 1996 Mar;10(3):327-8. doi: 10.1007/BF00187382.
The purpose of this review was to evaluate the incidence of postoperative intraabdominal abscess formation following laparoscopic and open appendectomies.
The current study retrospectively examines appendectomies performed during the period from January 1993 to July 1994. Excluded were cases which were started laparoscopically but converted to open procedures. There were 1,287 cases identified; 597 were perforated (46%), 114 were gangrenous (9%), and 576 were acute (45%). These diagnoses represent intraoperative diagnoses.
Of the 576 appendectomies for acute appendicitis, 64 (11%) were performed laparoscopically. There were four intraabdominal abscesses (0.7%), all occurring after open procedures. Of the 114 appendectomies for gangrenous appendicitis, 16 (14%) were done laparoscopically. There were two postoperative abscesses (1.8%), one following an open and one following a laparoscopic procedure. There was no significant difference in abscess rate between laparoscopic and open appendectomies for either acute or gangrenous appendicitis. Of the 597 appendectomies for perforated appendicitis, 28 (5%) were done laparoscopically. There were 19 postoperative abscesses in the whole group, accounting for a 3.2% abscess rate. Sixteen abscesses occurred after open appendectomies and three occurred after laparoscopic appendectomies (2.9% vs 11%, P = 0.054). The preoperative diagnosis was incorrectly identified as acute appendicitis in 95 cases subsequently found to have perforated appendicitis; there was only 1 postoperative abscess in this group. There was no difference in postoperative stay in the open vs laparoscopic group (6.3 days vs 6.1 days).
We found no significant difference in the rate of postoperative intraabdominal abscess formation between laparoscopic and open appendectomies in cases of acute or gangrenous appendicitis. However, laparoscopic appendectomy for perforated appendicitis was associated with an important trend toward a higher rate of postoperative intraabdominal abscess formation than open appendectomy. This observation calls for closer prospective scrutiny of laparoscopic appendectomy in the setting of perforated appendicitis.
本综述的目的是评估腹腔镜阑尾切除术和开腹阑尾切除术后腹腔内脓肿形成的发生率。
本研究回顾性分析了1993年1月至1994年7月期间进行的阑尾切除术。排除了开始采用腹腔镜手术但转为开腹手术的病例。共确定了1287例病例；其中597例为穿孔性阑尾炎（46%），114例为坏疽性阑尾炎（9%），576例为急性阑尾炎（45%）。这些诊断均为术中诊断。
在576例急性阑尾炎阑尾切除术中，64例（11%）采用腹腔镜手术。发生了4例腹腔内脓肿（0.7%），均发生在开腹手术后。在114例坏疽性阑尾炎阑尾切除术中，16例（14%）采用腹腔镜手术。发生了2例术后脓肿（1.8%），1例发生在开腹手术后，1例发生在腹腔镜手术后。急性或坏疽性阑尾炎的腹腔镜阑尾切除术和开腹阑尾切除术的脓肿发生率无显著差异。在597例穿孔性阑尾炎阑尾切除术中，28例（5%）采用腹腔镜手术。全组共发生19例术后脓肿，脓肿发生率为3.2%。16例脓肿发生在开腹阑尾切除术后，3例发生在腹腔镜阑尾切除术后（2.9%对11%，P = 0.054）。95例术前诊断为急性阑尾炎的病例随后被发现为穿孔性阑尾炎；该组仅发生1例术后脓肿。开腹组和腹腔镜组的术后住院时间无差异（6.3天对6.1天）。
我们发现，急性或坏疽性阑尾炎病例中，腹腔镜阑尾切除术和开腹阑尾切除术后腹腔内脓肿形成的发生率无显著差异。然而，穿孔性阑尾炎的腹腔镜阑尾切除术与术后腹腔内脓肿形成率高于开腹阑尾切除术的重要趋势相关。这一观察结果要求在穿孔性阑尾炎的情况下对腹腔镜阑尾切除术进行更密切的前瞻性研究。
