开腹阑尾切除术与腹腔镜阑尾切除术的对比研究_医学论文.docVIP

开腹阑尾切除术与腹腔镜阑尾切除术的对比研究_医学论文 开腹阑尾切除术与腹腔镜阑尾切除术的对比研究_医学论文 李纯坚，殷 奇，文习刚，罗金波 　　　　　　　　　　　　　　　　　　　　　【摘要】 目的 比较腹腔镜阑尾切除术（LA）与开腹阑尾切除术（OA）的临床疗效。方法 本院通过预期的随机双盲研究来进行腹腔镜阑尾切除术（LA）与开腹阑尾切除术（OA）以及多临床外科中心资料的Meta分析（荟萃分析），在手术安全性与两种手术方式在各自优越性方面的比较。结果 两种手术方式的术后并发症发生率相近（腹腔镜阑尾切除术组为18.5%，而开腹阑尾切除手术组为17.1%）。但腹腔镜术后的一些早期并发症需要再次手术，腹腔镜阑尾切除术的手术时间较长（LA：80min，OA：60min，P=0.000）。而2周后两种手术方式术后的恢复情况开始有差异：在活动能力及伤口疼痛方面差异无显著性，而身体的健康状况和生活质量比较（SF-36评分）方面，LA组显得比OA组要稍好一些。对于发生了急性期并发症（阑尾穿孔或阑尾周围脓肿形成）的急性阑尾炎患者行阑尾切除术的术后并发症相似（抛开技术因素，P=0.181）。多临床外科中心资料的Meta分析（荟萃分析）。两种手术方式的手术时间相近。但住院时间LA组明显短于OA组，切口感染率LA组少于OA组。结论 与其他的微创手术过程不同，LA并没有表现出在各个方面都优于OA，除了在2周后的生活质量方面稍优于OA。同时LA组的手术时间相对长一些，而且费用较开腹阑尾切除组高。所以手术方式的选择还是基于外科医生对何种手术方式更熟练，及患者更喜爱选择何种手术方式。 【关键词】 阑尾切除术；腹腔镜；研究 【Abstract】 Objective Our aim is to compare the safety and benefits of laparoscopic versus open appendectomy.Methods Two hundred and forty-seven patients in our hospital were analyzed with prospective randomized double-blind study following either laparoscopic or open appendectomy. And others prospective randomized studies (PRS) were analyzed with meta-analyses.Results The overall complication rate was similar in both groups (18.5% versus 17% in the laparoscopic and open groups respectively)， but some early complications in the laparoscopic group required a reoperation. Operating time was similar in the laparoscopic group.There was longer length of stay and higher expense in the laparoscopic group and there was no difference in the pain scores and medications， resumption of diet， or activity scores. At 2 weeks， there was no difference in the activity or pain scores， but physical function and physical health scores on the short-form 36 (SF36) quality of life assessment forms were little better in the laparoscopic group. Appendectomy for acute or complicated (perforated and gangrenous)appendicitis had similar complication rates， regardless of the technique (P=0.181). The result of PRS meta-analyses is that operating time was similar in the laparoscopic group.There was longe