复杂性阑尾炎术式的抉择：腹腔镜术抑或开腹手术.DOCVIP

临床医学论文-复杂性阑尾炎术式的抉择：腹腔镜术抑或开腹手术 ????????? 作者：颜松龄，张道建，吴锦城，纪程宏，郭久冰，徐文军 【摘要】? 目的：探讨腹腔镜应用于复杂性阑尾炎的可行性。方法：回顾分析手术治疗复杂性阑尾炎213例患者的临床资料，213例分为腹腔镜阑尾切除术(laparoscopic appendectomy,LA)128例，开腹阑尾切除术(open appendectomy,OA)85例。比较两组的手术时间、术中出血量、切口长度、术中引流管留置率及术后留置时间、术后疼痛视觉模拟评分(visual analogue scale,VAS)、恢复进食时间、感染性并发症（即切口感染、腹腔内脓肿）发生率、术后住院天数、住院费用等指标。结果：LA组比OA组手术时间长，住院总费用高，差异有统计学意义；术中出血量、切口长度、术中引流管留置率及术后留置时间、术后疼痛VAS、恢复进食时间及术后住院天数等指标，LA组均优于OA组；LA组切口感染率较OA组低，腹腔内脓肿发生率两组无显著性差异。两组均无死亡病例。结论：LA具有创伤小、疼痛轻、肠道功能恢复快、切口感染率低、住院时间短等优势，用于治疗复杂性阑尾炎可行、安全、有效。 【关键词】? 复杂性阑尾炎；腹腔镜术；阑尾切除术；开腹术 ?????? 【Abstract】? Ｏbjective:To investigate the feasibility of laparoscopic appendectomy(LA) for complicated appendicitis by comparing the clinical outcomes of laparoscopic and open approaches.Methods:The clinical data of 213 cases with complicated appendecitis underwent operations was analyzed retrospectively.128 underwent LA and 85 underwent open appendectomy(OA).Operative time,intraoperative blood loss,length of incision,drainage,postoperative pain in visual analogue scale (VAS),resumption to diet,infectious complications (i.e,wound infection,intraabdominal abscess),length of hospitalization and cost were compared.Results:Compared with that of OA group the operative time of LA group was significanty longer and total cost was significanty higher,but OA group had more intraoperative blood loss,longer incision,more frequent drainage,higher postoperative VAS,later resumption to diet and longer hospitalization compared with LA group.Incidence of wound infetion in LA group was lower,while significant difference can t be found when the rate of postoperative intraabdominal abscess was compared between two groups.No mortality was observed in both groups.Conclusions:Laparoscopic appendectomy for complicated appendicitis is feasible,safe and effective.It has significant advantages over open appendectomy with less trauma,less postoperative pain,faster resumption to diet,lower incidence of wound infection and shorter hospitalization. ???