腹腔镜治疗复杂性和非复杂性阑尾炎的疗效分析

中国临床药理学与治疗学 ›› 2013, Vol. 18 ›› Issue (7): 794-799.

腹腔镜治疗复杂性和非复杂性阑尾炎的疗效分析

王明海, 赵国海, 史良会, 陈方正, 夏亚斌, 徐冉, 吴泽晖, 赵军, 张义胜

安徽省皖南医学院第一附属弋矶山医院普外科,芜湖 241001,安徽

收稿日期:2013-05-21 修回日期:2013-06-05 出版日期:2013-07-26 发布日期:2013-06-20
通讯作者: 张义胜,本科,主任医师,硕士生导师,研究方向:普外科,微创。E-mail: zhangys0109@hotmail.com
作者简介:王明海,男,博士,主治医师,研究方向:普外科,微创。E-mail: wangmh0410@sina.com
基金资助:
皖南医学院中青年课题(WK200706F)

Comparative study of laparoscopic appendectomy for complicated and uncomplicated acute appendicitis

WANG Ming-hai, ZHAO Guo-hai, SHI Liang-hui, CHEN Fang-zheng, XIA Ya-bin, XU Ran, WU Ze-hui, ZHAO Jun, ZHANG Yi-sheng

Department of General Surgery, the First Affiliated Yijishan Hospital with Wannan Medical College, Wuhu 241001, Anhui, China

Received:2013-05-21 Revised:2013-06-05 Online:2013-07-26 Published:2013-06-20

摘要/Abstract

摘要： 目的: 比较腹腔镜阑尾切除术在复杂性阑尾炎(Complicated acute appendicitis, CAA)和非复杂性阑尾炎(Uncomplicated acute appendicitis, UCAA)中的疗效。方法: 收集本院2011年1月至2013年2月腹腔镜手术治疗急性阑尾炎患者术前、术中和术后的临床资料,比较CAA组和UCAA组发病时间、弥漫性腹膜炎发生率、血白细胞计数、中性粒细胞比例、腹腔脓液量、腹腔冲洗率、腹腔引流率、手术时间、下床活动时间、肛门通气时间、住院时间、住院费用以及术后并发症的发生率。结果: 共有149例患者行腹腔镜阑尾切除术,其中133例病例符合纳入标准。CAA组有48例,UCAA组有85例,无手术死亡发生。术前,CAA组患者在发病时间、弥漫性腹膜炎发生率、血白细胞计数、中性粒细胞比例方面均明显高于UCAA组患者(均P<0.05)。术中,CAA组患者腹腔内脓液量、腹腔冲洗率、腹腔引流率和手术时间均显著高于UCAA组患者(均P<0.05)。CAA组有4例中转开腹手术,UCAA组有2例中转开腹手术,两组手术中转率无统计学差异(8.3% vs 2.4%,P>0.05)。术后,两组下床活动时间、肛门通气时间、Trocar孔感染率、腹腔脓肿发生率、肠梗阻发生率均无统计学差异(均P>0.05)。两组的住院时间和住院费用亦无统计学差异(均P>0.05)。结论: 虽然复杂性阑尾炎比非复杂性阑尾炎的炎症重,但腹腔镜治疗复杂性阑尾炎的疗效与非复杂性阑尾炎相当。因此,腹腔镜技术应用于复杂性阑尾炎的治疗可能是一种可行、安全和有效的方法。

关键词: 腹腔镜, 阑尾炎, 阑尾切除术

Abstract: AIM: To investigate the effect of laparoscopic appendectomy in both complicated and uncomplicated cases of acute appendicitis.METHODS: A retrospective, observational study design was used to analyze several outcomes using the data of all laparoscopic appendectomy procedures from January 2011 to February 2013 in patients with complicated or uncomplicated appendicitis. Data on several surgical outcome measures were collected.RESULTS: A total of 149 laparoscopic appendectomy procedures performed. 133 patients with complicated or uncomplicated acute appendicitis were included in the study. There was no mortality in both CAA group with 48 cases and UCAA group with 85 cases. Preoperatively, in patients with CAA, duration of symptoms, incidence rate of diffuse peritonitis, blood leukocyte count, neutrophil percentage were significantly higher than in patients with UCAA (all P<0.05).Intraoperatively, in patients with CAA, quantity of pus, peritoneal irrigation rate, peritoneal drainage rate and operation time were significantly higher than in patients with UCAA (all P<0.05). Conversion to open surgery was necessary in 4 patients in CAA group and in 2 patients in UCAA group. Conversion rate had no significant difference between two groups (8.3% for CAA vs 2.4% for UCAA, P>0.05).Postoperatively, two groups of ambulation time, restoration of anal exhaust, incidence rate of Trocar hole infection, incidence rate of intra-abdominal abscess, incidence rate of bowel obstruction had no significant difference (P>0.05). In the two groups, the difference between the length of hospital stay and hospital costs also had no statistical significance (P>0.05).CONCLUSION: Laparoscopic appendectomy for complicated acute appendicitis is comparable to uncomplicated acute appendicitis in terms of several surgical outcomes, although the inflammatory response in patients with complicated acute appendicitis is more serious than uncomlicated acute appendicitis. Therefore, laparoscopic technique may be a feasible, safe, and efficacious method in the therapy of complicated acute appendicitis.

Key words: Laparoscope, Appendicitis, Appendectomy

中图分类号:

R656.8

王明海, 赵国海, 史良会, 陈方正, 夏亚斌, 徐冉, 吴泽晖, 赵军, 张义胜. 腹腔镜治疗复杂性和非复杂性阑尾炎的疗效分析[J]. 中国临床药理学与治疗学, 2013, 18(7): 794-799.

WANG Ming-hai, ZHAO Guo-hai, SHI Liang-hui, CHEN Fang-zheng, XIA Ya-bin, XU Ran, WU Ze-hui, ZHAO Jun, ZHANG Yi-sheng. Comparative study of laparoscopic appendectomy for complicated and uncomplicated acute appendicitis[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2013, 18(7): 794-799.

参考文献

[1] Chan L, Shin LK, Pai RK, et al. Pathologic continuum of acute appendicitis: sonographic findings and clinical management implications[J]. Ultrasound Q,2011, 27(2):71-79.
[2] 戴显伟. 急性阑尾炎[M] //陈孝平, 主编. 外科学.1版. 北京:人民卫生出版社, 2002:607-611.
[3] Menezes M, Das L, Alagtal M, et al. Laparoscopic appendectomy is recommended for the treatment of complicated appendicitis in children[J]. Pediatr Surg Int,2008, 24(3):303-305.
[4] Cash C, Frazee R. Improvements in laparoscopic treatment for complicated appendicitis[J]. J Laparoendosc Adv Surg Tech A,2012, 22(6):581-583.
[5] Shindholimath VV, Thinakaran K, Rao TN, et al. Laparoscopic management of appendicular mass[J]. J Minim Access Surg,2011, 7(2):136-140.
[6] Lim SG, Ahn EJ, Kim SY, et al. A Clinical Comparison of Laparoscopic versus Open Appendectomy for Complicated Appendicitis[J]. J Korean Soc Coloproctol,2011, 27(6):293-297.
[7] St Peter SD, Aguayo P, Fraser JD, et al. Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial[J]. J Pediatr Surg,2010, 45(1):236-240.
[8] Dimitriou I, Reckmann B, Nephuth O, et al. Single institution's experience in laparoscopic appendectomy as a suitable therapy for complicated appendicitis[J]. Langenbecks Arch Surg,2013, 398(1):147-152.
[9] Delibegovic S. Basic principles of laparoscopic appendectomy[J]. Med Pregl,2012, 65(9/10):383-387.
[10] Wu HS, Lai HW, Kuo SJ, et al. Competitive edge of laparoscopic appendectomy versus open appendectomy: a subgroup comparison analysis[J]. J Laparoendosc Adv Surg Tech A,2011, 21(3):197-202.
[11] Gomes CA, Nunes TA, Fonseca Chebli JM, et al. Laparoscopy grading system of acute appendicitis: new insight for future trials[J]. Surg Laparosc Endosc Percutan Tech,2012, 22(5):463-466.
[12] Tuggle KR, Ortega G, Bolorunduro OB, et al. Laparoscopic versus open appendectomy in complicated appendicitis: a review of the NSQIP database[J]. J Surg Res,2010, 163(2):225-228.
[13] Semm K. Endoscopic appendectomy[J]. Endoscopy Mar, 1983,15(2):59-64.
[14] Kaplan M, Salman B, Yilmaz TU, et al. A quality of life comparison of laparoscopic and open approaches in acute appendicitis: a randomised prospective study[J]. Acta Chir Belg,2009, 109(3):356-363.
[15] Markar SR, Blackburn S, Cobb R, et al. Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children[J]. J Gastrointest Surg,2012, 16(10):1993-2004.
[16] Ferranti F, Corona F, Siani LM, et al. Laparoscopic versus open appendectomy for the treatment of complicated appendicitis[J]. G Chir,2012, 33(8/9):263-267.
[17] Vettoretto N, Montori G, Bartoli M, et al. Lesson learned from 10 years' experience in laparoscopic appendectomy in a community hospital[J]. Updates Surg,2012, 64(4):285-288.
[18] Khiria LS, Ardhnari R, Mohan N, et al. Laparoscopic appendicectomy for complicated appendicitis: is it safe and justified?: A retrospective analysis[J]. Surg Laparosc Endosc Percutan Tech,2011, 21(3):142-145.
[19] D'Ambra L, Berti S, Bonfante P, et al. Laparoscopic appendectomy for complicated acute appendicitis[J]. G Chir,2011, 32(4):181-184.
[20] Tiwari MM, Reynoso JF, Tsang AW, et al. Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis[J]. Ann Surg,2011,254(6):927-932.