Saviano M, Piccoli M, Menozzi M, Gelmini R, Heydari A
Dipartimento di Chirurgia, Università degli Studi, Modena.
Minerva Chir. 1998 Jan-Feb;53(1-2):15-21.
The authors report on their experience of 235 laparotomy operations and 125 laparoscopic operations performed on patients with right lower abdominal pain. Concerning each of these different approaches, the authors analyzed and compared preoperative diagnosis, anatomo-pathological findings, intraoperative and early post operative morbidity and hospital stay. The ratio of negative open-appendectomies was 24.1% (56 cases out of 233). The laparoscopic approach, performed on 88 cases of suspected appendicitis, allowed to document and to treat other pathologies, real causes of the lower right abdominal pain, in 42 cases (47.7%). The rate of conversion from laparoscopic appendectomy to open appendectomy was only 2.19% (2 cases out of 91). The morbidity rate of laparoscopic appendectomy was estimated at 6.5% (4.4% major complications, 2.2% minor complications). The morbidity rate of open appendectomy was estimated at 8.9% (0.4% major complications, 8.5% minor complications). Though the median postoperative stay, after laparotomy approach, was slightly longer (2.6 days versus 2.4 days), the difference was not statistically significant. Based on these results, the authors conclude that the laparoscopic approach should be reserved for fertile female patients, especially when the diagnosis of appendicitis is uncertain.
作者报告了他们对235例接受剖腹手术和125例接受腹腔镜手术的右下腹痛患者的治疗经验。针对每种不同的手术方式，作者分析并比较了术前诊断、解剖病理学发现、术中及术后早期的发病率和住院时间。阴性开腹阑尾切除术的比例为24.1%（233例中有56例）。对88例疑似阑尾炎患者采用腹腔镜手术方式，发现并治疗了42例（47.7%）其他导致右下腹痛的真正病因。从腹腔镜阑尾切除术转为开腹阑尾切除术的比例仅为2.19%（91例中有2例）。腹腔镜阑尾切除术的发病率估计为6.5%（严重并发症占4.4%，轻微并发症占2.2%）。开腹阑尾切除术的发病率估计为8.9%（严重并发症占0.4%，轻微并发症占8.5%）。尽管剖腹手术方式术后的中位住院时间略长（2.6天对2.4天），但差异无统计学意义。基于这些结果，作者得出结论，腹腔镜手术方式应仅用于育龄女性患者，尤其是在阑尾炎诊断不确定时。
