开腹阑尾切除术和腹腔镜阑尾切除术择用的临床价值研究

摘要

[目的]探讨开腹阑尾切除术(open appendectomy,OA)和腹腔镜阑尾切除术(laparoscopicappendectomy,LA)两种不同手术方案的显效性.[方法]取湖州中心医院和我院2007年2月至2012年6月行阑尾切除术患者162例为本研究病例并将患者分为治疗组81例(行LA),对照组81例(行OA),以上分组以患者年龄、性别、病情比例均分为前提条件,无统计学差异(P＞0.05),具有可比性.[结果]治疗组患者术后恢复下床行动能力较对照组明显快(P＜0.01):疼痛评分、住院时间,治疗组较对照组有优势(P＜0.05)；术后距排气时间,治疗组与对照组比较,差异无统计学意义(P＞0.05)；手术所用时间、感染率、住院费用方面,对照组较治疗组有优势(P＜0.05)；术后并发症率治疗组0％(0/81)低于对照组1.23％(1/81),差异有统计学意义(P＜0.05)；中转治疗组2例,对照组1例.[结论]OA、LA两种手术方案在治疗阑尾炎患者有不同优势.%[Objective]To further explore and discuss the value of laparoscopic appendectomy. [Methods]The clinical data of 260 patients undergoing appendectomy in this hospital from April 2008 to December 2012 were collected.The operation time, postoperative hospital stay,cost of hospitalization, postoperative anal exhaust time,postoperative pain score and surgical complications were compared between laparoscopie appendectomy and open appendectomy. [Results]There were 8 cases conversion to the open approach in this series.The cost of laparoscopic appendectomy was higher than that of open appendectomy, the cases of chronic appendicitis,acute simple appendicitis,acute suppurative appendicitis within 36h of onset treated by laparoscopic appendectomy had shorter operation time .shorter postoperative hospital stay, earlier postoperative anal exhaust time, and slighter postoperative pain than those treated by open appendectomy; the differences in postoperative hospital stay,postoperative anal exhaust time,postoperative pain of acute suppurative appendicitis more than 36h of onset and acute gangrenous appendicitis treated by two types of surgery had no statistical significances. The operation time of acute gangrenous appendicitis operated by laparoscopic surgery was longer than that by open appendectomy. Incision infection rate of laparoscopic appendectomy was lower than that of open appendectomy. [Conclusions] For chronic appendicitis,acute simple appendicitis,and acute suppurative appendicitis within 36h of onset, the outcome and advantages of laparoscopic appendectomy are outstanding,the value of application is clear;and for acute suppurative appendicit more than 36h of onset and acute gangrenous appendicitis, laparoscopic appendectomy is difficult and with high rate of conversion, no obvious advantages in recovery after surgery but an increase of medical COSTS and the application value is not great.