Stringel G, Zitsman J L, Shehadi I, Kithir S
Department of Surgery, Westchester County Medical Center, Valhalla, NY, USA.
JSLS. 1997 Jan-Mar;1(1):37-9.
The advantages of laparoscopic appendectomy over open appendectomy have not yet been clearly demonstrated. The present study evaluated our early experience with laparoscopic appendectomy in children, in terms of its safety, effectiveness, technical difficulties, and economics.
We reviewed the records of 50 cases involving laparoscopic appendectomy performed at our affiliated institutions between September, 1994, and September, 1996. Patient age ranged from 6 to 18 years (mean, 14 years). Thirty-two patients had acute nonperforated appendicitis, six had perforated appendicitis, two had fibrosis of the appendix, and ten had a histologically normal appendix.
In five patients the laparoscopic procedures were converted to open appendectomies because of technical difficulties. There were postoperative complications in four patients: one incomplete appendectomy which subsequently required an open appendectomy for completion, one pelvic abscess, one bowel obstruction, and one minor wound infection.
Laparoscopic appendectomy is a safe and effective procedure. It takes longer operative time than open appendectomy. Length of hospitalization and incidence of postoperative complications are equivalent to those of open appendectomy. Economic benefits are difficult to assess at present. In sum, we believe that with better training, surgical techniques and equipment, laparoscopic appendectomy will eventually become the surgical procedure of choice in appendicitis.
腹腔镜阑尾切除术相对于开腹阑尾切除术的优势尚未得到明确证实。本研究评估了我们在儿童腹腔镜阑尾切除术中的早期经验，包括其安全性、有效性、技术难度和经济性。
我们回顾了1994年9月至1996年9月期间在我们附属机构进行的50例腹腔镜阑尾切除术的记录。患者年龄在6至18岁之间（平均14岁）。32例患者患有急性非穿孔性阑尾炎，6例患有穿孔性阑尾炎，2例患有阑尾纤维化，10例阑尾组织学正常。
5例患者因技术困难将腹腔镜手术转为开腹阑尾切除术。4例患者出现术后并发症：1例阑尾切除不完全，随后需要开腹阑尾切除术完成手术；1例盆腔脓肿；1例肠梗阻；1例轻微伤口感染。
腹腔镜阑尾切除术是一种安全有效的手术。其手术时间比开腹阑尾切除术长。住院时间和术后并发症发生率与开腹阑尾切除术相当。目前难以评估经济效益。总之，我们认为随着更好的培训、手术技术和设备，腹腔镜阑尾切除术最终将成为阑尾炎的首选手术方式。
