开腹手术与腹腔镜微创技术治疗小儿坏疽穿孔性阑尾炎的临床对比研究

发布时间：2018-12-12 01:46

【摘要】：目的回顾性对比分析开腹手术与腹腔镜微创技术治疗小儿坏疽穿孔性阑尾炎的临床疗效,为临床合理选择手术方式提供帮助。方法收集2014年5月-2016年3月期间就诊宁夏医科大学总医院小儿外科并行手术治疗的288例坏疽穿孔性阑尾炎患儿临床病历资料,依据手术方式分为开腹手术组(162例)与腹腔镜微创技术组(126例),对两组资料的性别、年龄、民族、院前病程时间、术前体温、术前白细胞总数、术前中性粒细胞比值、手术时间、术后排气时间、术后抗生素使用时间、腹腔引流管留置率、住院时间、住院费用、术后切口感染发生率、术后腹腔脓肿发生率及术后粘连性肠梗阻发生率进行研究,综合对比分析两种手术方式治疗小儿坏疽穿孔性阑尾炎的临床疗效。数据结果采用SPSS 22.0软件进行统计学分析,两组之间计量资料用均数±标准差(Sx±)表示,采用t检验进行比较,计数资料采用χ~2检验进行比较,当P0.05有统计学意义。结果1.开腹手术组与腹腔镜微创技术组的性别、年龄、民族、院前病程时间、术前体温、术前白细胞总数、术前中性粒细胞比值、手术时间、术后腹腔脓肿发生率、术后粘连性肠梗阻发生率等,组间差异均无统计学意义(P0.05)。2.开腹手术组与腹腔镜微创技术组的平均术后排气时间(38.81±16.80h,29.89±13.43h)、平均术后抗生素使用时间(8.59±2.26d,6.43±1.80d)、平均住院时间(9.59±4.38d,6.61±2.10d)、平均住院费用(14961.39±3336.92元,16508.51±2367.90元)、腹腔引流管留置率(72.22%,29.37%)、术后切口感染发生率(12.96%,0.79%)等,组间差异均有统计学意义(P0.05)。结论与开腹手术相比,腹腔镜微创技术治疗小儿坏疽穿孔性阑尾炎术后排气时间、抗生素使用时间、住院时间短且术后切口感染率低,但增加了住院费用。
[Abstract]:Objective to compare the clinical effects of laparotomy and laparoscopic minimally invasive technique in the treatment of infantile gangrenous perforated appendicitis. Methods from May 2014 to March 2016, 288 children with gangrenous perforated appendicitis who were treated with pediatric surgery and surgical treatment in General Hospital of Ningxia Medical University were collected. The patients were divided into open operation group (162 cases) and laparoscopic minimally invasive technique group (126 cases) according to the operation method. The data of the two groups were sex, age, nationality, duration of disease before hospital, preoperative body temperature, preoperative white blood cell count and preoperative neutrophil ratio. The operative time, postoperative exhaust time, postoperative antibiotic use time, abdominal drainage tube indwelling rate, hospitalization time, hospitalization cost, postoperative incision infection, postoperative abdominal abscess and postoperative adhesive intestinal obstruction were studied. To compare and analyze the clinical effect of two surgical methods in treating children with gangrenous perforated appendicitis. The data were analyzed by SPSS 22.0 software. The measurement data between the two groups were expressed as mean 卤standard deviation (Sx 卤). T test was used to compare the data and 蠂 ~ 2 test was used to compare the count data. Result 1. Sex, age, nationality, prehospital duration, preoperative body temperature, preoperative leukocyte count, preoperative neutrophil ratio, operative time, incidence of postoperative abdominal abscess in laparotomy group and laparoscopy minimally invasive group. There was no significant difference in the incidence of adhesive intestinal obstruction between the two groups (P0.05). The mean postoperative exhaust time (38.81 卤16.80 h), postoperative antibiotic use time (8.59 卤2.26 d) and mean hospitalization time (9.59 卤4.38 d) in the laparotomy group and the laparoscopic minimally invasive group were (38.81 卤16.80 h 卤13.43 h), (8.59 卤2.26 d) and (6.43 卤1.80) days, respectively. The average hospitalization expenses (14961.39 卤3336.92 yuan, 16508.51 卤2367.90 yuan), abdominal drainage tube retention rate (72.22 ~ 29.37%) and postoperative incision infection rate (12.96 ~ 0.79%) were 6.61 卤2.10 days. The differences between groups were statistically significant (P0.05). Conclusion compared with open surgery, laparoscopic minimally invasive treatment for children with gangrenous perforated appendicitis after the exhaust time, antibiotic use time, hospital stay and postoperative incision infection rate is lower, but increased the cost of hospitalization.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.5

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