腹腔镜和开腹阑尾切除术治疗儿童复杂性阑尾炎的回顾性研究-可编辑.docVIP

腹腔镜与开腹阑尾切除术治疗儿童复杂性阑尾炎的回顾性研究 王小林，张文，邵景范，杨小进，周学峰，袁继炎 华中科技大学同济医学院同济医院小儿外科 湖北 武汉 430030 【摘要】　目的　对比分析腹腔镜与开腹阑尾切除术治疗儿童复杂性阑尾炎，以评价腹腔镜应用于儿童复杂性阑尾炎的效果。方法 回顾分析手术治疗儿童复杂性阑尾炎189例的临床资料，其中分为腹腔镜阑尾切除术(laparoscopic appendectomy，LA)113例,开腹阑尾切除术(open appendectomy，OA)76例。比较两组的手术时间、术中出血量、开始恢复进食时间、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、抗生素使用时间及手术费用等指标。结果:LA组手术时间(94.5±27.7min)明显长于OA组(80.8±35.6min) (t=2.968,P=0.003)。LA组手术费用(2696.5±521.5)用高于OA组(2150.8±415.5)(t=7.635,P0.001)。LA术中出血量(36.8±22.5ml)少于OA组(45.6±32.5ml)(t=-2.200,P=0.029)。LA组术后开始进食时间(1.8±0.7d)明显短于OA组(2.7±0.5d) (t=-9.668,P0.001)。LA组住院时间(6.8±2.5d)显著短于OA组(7.9±2.8d) (t=-2.825,P=0.005)。 LA组切口感染率及腹腔内脓肿发生率较OA组低(P0.05)。LA组术后抗生素使用时间(5.6±1.5d)短于OA组(6.1±2.8d),但两组无显著性差异(t=-1.590,P=0.113)。两组均无死亡病例。结论:LA具有创伤小、恢复快、并发症少及住院时间短等优点，可用于治疗儿童复杂性阑尾炎，是一种可行、安全、有效的治疗方法。 【关键词】　儿童，回顾性研究，阑尾炎，腹腔镜阑尾切除术，开腹术 Laparoscopic versus open appendectomy for complicated appendicitis in children: an retrospective study. WANG Xiaolin, Zhang Wen, Yang Xiaojin， Shao Jinfan，Zhou Xuefeng，Yuan Jiyan Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science Technology, 430030 Wuhan, P.R. China [Abstract] Objective: To investigate the feasibility of laparoscopic appendectomy for complicated appendicitis by comparing the efficacy of laparoscopic appendectomy (LA) and open appendectomy (OA) for complicated appendicitis in children. Methods: The clinical data of 189 cases with complicated appendicitis underwent operations was analyzed retrospectively.113underwent LA and 76 underwent OA. Operative time、intra-operative blood loss、resumption to diet、infectious complications(wound infection and intra-abdominal abscess)、length of hospitalization、the periods of antibiotic use and total cost were compared. Results: The operative time in the LA group was significantly longer than that in the OA group (94.5±27.7 vs 80.8±35.6) min (t=2.968, P=0.003). The estimated blood loss (36.8±22.5 vs 45.6±32.5) mL (t=-2.200, P=0.029) was lower between LA and OA. The pati