Klingler A, Henle K P, Beller S, Rechner J, Zerz A, Wetscher G J, Szinicz G
Department of General Surgery II, University of Innsbruck, Austria.
Am J Surg. 1998 Mar;175(3):232-5. doi: 10.1016/s0002-9610(97)00286-9.
It is not clear whether the laparoscopic approach does decrease the incidence of postoperative infectious complications after appendectomy.
One hundred sixty-nine patients were randomized, 87 with laparoscopic (LA) and 82 with open appendectomy (OA). Patients in the OA group had a McBurney incision; LA was performed in the lithotomy position.
Acute appendicitis was confirmed in 75% of patients. The appendix was perforated in 5 patients of the LA versus 2 patients of the OA group. No conversion to the open procedure was necessary. The median operating time was 35 minutes in the LA group and 31 minutes in the open group (P = 0.58). The median postoperative hospital stay was shorter after laparoscopic than after open surgery (3 days versus 4 days, P = 0.026), whereas the time required for return to work was not significantly different (14 versus 15 days). There were 5 (6%) patients with superficial wound infection following LA and 6 (7%) after OA (P = 0.67). Intra-abdominal fluid collections were found in 2 (2%) patients following LA and 3 (4%) patients following OA (P = 0.60). In the LA group, 3 patients presented with intra-abdominal hemorrhage and another 3 developed a paralytic ileus that was treated conservatively.
Laparoscopic appendectomy is as safe and as effective as the open procedure; however, it does not decrease the rate of postoperative infectious complications.
腹腔镜手术方式是否真的能降低阑尾切除术后感染性并发症的发生率尚不清楚。
169例患者被随机分组，87例行腹腔镜阑尾切除术（LA），82例行开腹阑尾切除术（OA）。OA组患者采用麦氏切口；LA组在截石位进行手术。
75%的患者确诊为急性阑尾炎。LA组有5例阑尾穿孔，OA组有2例。无需转为开腹手术。LA组中位手术时间为35分钟，开腹组为31分钟（P = 0.58）。腹腔镜术后中位住院时间短于开腹手术（3天对4天，P = 0.026），而恢复工作所需时间无显著差异（14天对15天）。LA术后有5例（6%）患者发生浅表伤口感染，OA术后有6例（7%）（P = 0.67）。LA术后有2例（2%）患者出现腹腔内积液，OA术后有3例（4%）（P = 0.60）。LA组有3例患者出现腹腔内出血，另有3例发生麻痹性肠梗阻，均经保守治疗。
腹腔镜阑尾切除术与开腹手术一样安全有效；然而，它并不能降低术后感染性并发症的发生率。
