急性化脓性阑尾炎及坏疽性阑尾炎腹腔镜手术与开放手术的临床对比研究
发布时间：2018-07-27 13:36
【摘要】：目的评价腹腔镜阑尾切除术(Laparoscopic appendectomy,LA)在治疗急性化脓性及坏疽性阑尾炎的优缺点。方法本研究采取回顾性研究,检索2011年1月-2015年12月期间在我院普通外科行阑尾切除术的所有患者,其中行腹腔镜阑尾切除术患者449例,行开腹阑尾切除术(open appendectomy,OA)患者394例。将经纳入标准及排除标准筛选后最后纳入LA组270例、OA组222例作为研究对象。搜集患者的一般临床资料,首先比较一般资料差异无统计学意义,然后对两组患者的切口长度、出血量、手术时间、术后住院时间、止痛药使用率、抗菌药物使用时间、静脉补液或静脉营养时间、术中探查情况、引流管放置率及留置时间、住院费用(总费用、术后费用)、并发症(切口感染、肠梗阻、腹腔脓肿)等发生率进行比较。结果腹腔镜组患者275例,5例中转开腹,剔除统计;开腹阑尾切除术患者222例;两组患者基本资料比较差异无统计学意义;腹腔镜组手术切口明显较短(LA组2.42±0.18,OA组4.81±2.17cm);腹腔镜组出血量明显较少(LA组9.20±8.85ml,OA组16.37±14.91ml);腹腔镜组引流管放置率较低,留置时间较短(LA组38例(14.1%)、1.66±1.10天,OA组68例(30.6%)、2.56±1.51天);差异均有统计学意义。腹腔镜组手术时间略长(LA组63.56±33.77,OA组63.24±20.52min),但差异无统计学意义。住院总费用略高(在LA组10358.47±1742.12元,OA组8388.86±2111.75元),但腹腔镜组术后花费反而较低(LA组3494.32±1672.91元,OA组3948.04±2111.75元),差异均有统计学意义。腹腔镜组恢复下地活动早(LA组6.85±2.30小时,OA组13.35±9.73小时),肛门恢复排气时间早(LA组15.60±8.72小时,OA组21.59±16.32小时),静脉补液或静脉营养的时间腹腔镜组短于开腹组(LA组1.87±0.69天,OA组3.47±1.79天);止痛药使用率较低(LA组19.6%,OA组48.7%),抗菌药物使用时间短(LA组3.67±1.42天,OA组5.74±3.16天),住院时间短(LA组6.51±3.81天,OA组4.50±1.86天),并发症发生较少(LA组5例(1.9%),OA组36例(16.2%)),差异均有统计学意义。结论1腹腔镜在急性化脓性阑尾炎及坏疽性阑尾炎的治疗中是安全有效的;2在急性化脓性阑尾炎及坏疽性阑尾炎的腹腔镜手术对比开腹手术具有恢复快、并发症低、住院时间短、出血少、切口美容效果好等优势;3腹腔镜手术开展早期手术时间明显长于开腹手术,后期手术时间明显缩短,甚至低于开腹组;4接受腹腔镜阑尾切除术患者住院总费用高于开腹手术组,主要费用为腔镜新技术、高值耗材、全麻费用,但术后恢复费用明显低于开腹手术组;5腹腔镜阑尾切除术可作为治疗急性化脓性阑尾炎及坏疽性阑尾炎的理想手术方式之一,可在临床中推广应用。
[Abstract]:Objective to evaluate the advantages and disadvantages of Laparoscopic appendectomy (LA) in the treatment of acute suppurative and gangrenous appendicitis. Methods A retrospective study was conducted to retrieve all the patients undergoing appendectomy in our hospital from January 2011 to December 2015, including 449 patients undergoing laparoscopic appendectomy and 394 patients undergoing open appendectomy (OA). After selection of inclusion criteria and exclusion criteria, 222 cases of OA group and 270 cases of LA group were included in the study. To collect the general clinical data of the patients, the difference in general data was not statistically significant first. Then, the incision length, bleeding volume, operation time, postoperative hospitalization time, painkiller utilization rate, time of use of antimicrobial agents were compared between the two groups. The time of venous resuscitation or venous nutrition, intraoperative exploration, drainage tube placement rate and retention time, total cost of hospitalization (total cost, postoperative cost), complications (incision infection, intestinal obstruction, celiac abscess) were compared. Results in the laparoscopic group, 275 cases were converted to open operation, and 222 cases underwent appendectomy, and there was no significant difference in basic data between the two groups. The operative incision in the laparoscopic group was significantly shorter (LA group 2.42 卤0.18 vs OA group 4.81 卤2.17cm), the bleeding volume in the laparoscopic group was significantly less (LA group 9.20 卤8.85 ml / OA group 16.37 卤14.91ml), the drainage tube placement rate in the laparoscopic group was lower, and the retention time was shorter (LA group 38 cases (14.1%) 1.66 卤1.10 days OA group, 68 cases (30.6%) 卤1.51 days), the difference was statistically significant. The operative time of laparoscopic group was a little longer (LA group 63.56 卤33.7 vs OA group 63.24 卤20.52min), but the difference was not statistically significant. The total cost of hospitalization was slightly higher (10358.47 卤1742.12 yuan in LA group, 8388.86 卤2111.75 yuan in OA group), but lower in laparoscopic group (3494.32 卤1672.91 yuan in LA group, 3948.04 卤2111.75 yuan in OA group). The recovery of subsurface activity was earlier in the laparoscopic group (6.85 卤2.30 hours in LA group, 13.35 卤9.73 hours in OA group), and the recovery time in anal exhaust was earlier (15.60 卤8.72 hours in LA group, 21.59 卤16.32 hours in OA group). The time of venous resuscitation or venous nutrition in laparoscopic group was shorter than that in open group (LA group 1.87 卤0.69 days OA group 3.47 卤1.79 days). The usage rate of analgesic was low (48.7% in LA group), the time of using antibiotics was short (5.74 卤3.16 days in LA group, 5.74 卤3.16 days in OA group), the hospitalization time was short (6.51 卤3.81 days in LA group, 4.50 卤1.86 days in OA group), and the complications were less (LA group 5 cases (1.9%), OA group 36 cases (16.2%),). Conclusion 1 Laparoscopy is safe and effective in the treatment of acute suppurative appendicitis and gangrenous appendicitis. The early operative time of laparoscopic surgery was significantly longer than that of open surgery, and the later operative time was shortened obviously. The total hospitalization cost of patients undergoing laparoscopic appendectomy was higher than that of laparotomy group. The main expenses were new endoscopic technology, high value consumables, general anesthesia, etc. But the cost of postoperative recovery was significantly lower than that of laparotomy group. Laparoscopic appendectomy was one of the ideal methods for the treatment of acute suppurative appendicitis and gangrenous appendicitis, and could be popularized in clinical practice.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.8
本文编号：2147998
[Abstract]:Objective to evaluate the advantages and disadvantages of Laparoscopic appendectomy (LA) in the treatment of acute suppurative and gangrenous appendicitis. Methods A retrospective study was conducted to retrieve all the patients undergoing appendectomy in our hospital from January 2011 to December 2015, including 449 patients undergoing laparoscopic appendectomy and 394 patients undergoing open appendectomy (OA). After selection of inclusion criteria and exclusion criteria, 222 cases of OA group and 270 cases of LA group were included in the study. To collect the general clinical data of the patients, the difference in general data was not statistically significant first. Then, the incision length, bleeding volume, operation time, postoperative hospitalization time, painkiller utilization rate, time of use of antimicrobial agents were compared between the two groups. The time of venous resuscitation or venous nutrition, intraoperative exploration, drainage tube placement rate and retention time, total cost of hospitalization (total cost, postoperative cost), complications (incision infection, intestinal obstruction, celiac abscess) were compared. Results in the laparoscopic group, 275 cases were converted to open operation, and 222 cases underwent appendectomy, and there was no significant difference in basic data between the two groups. The operative incision in the laparoscopic group was significantly shorter (LA group 2.42 卤0.18 vs OA group 4.81 卤2.17cm), the bleeding volume in the laparoscopic group was significantly less (LA group 9.20 卤8.85 ml / OA group 16.37 卤14.91ml), the drainage tube placement rate in the laparoscopic group was lower, and the retention time was shorter (LA group 38 cases (14.1%) 1.66 卤1.10 days OA group, 68 cases (30.6%) 卤1.51 days), the difference was statistically significant. The operative time of laparoscopic group was a little longer (LA group 63.56 卤33.7 vs OA group 63.24 卤20.52min), but the difference was not statistically significant. The total cost of hospitalization was slightly higher (10358.47 卤1742.12 yuan in LA group, 8388.86 卤2111.75 yuan in OA group), but lower in laparoscopic group (3494.32 卤1672.91 yuan in LA group, 3948.04 卤2111.75 yuan in OA group). The recovery of subsurface activity was earlier in the laparoscopic group (6.85 卤2.30 hours in LA group, 13.35 卤9.73 hours in OA group), and the recovery time in anal exhaust was earlier (15.60 卤8.72 hours in LA group, 21.59 卤16.32 hours in OA group). The time of venous resuscitation or venous nutrition in laparoscopic group was shorter than that in open group (LA group 1.87 卤0.69 days OA group 3.47 卤1.79 days). The usage rate of analgesic was low (48.7% in LA group), the time of using antibiotics was short (5.74 卤3.16 days in LA group, 5.74 卤3.16 days in OA group), the hospitalization time was short (6.51 卤3.81 days in LA group, 4.50 卤1.86 days in OA group), and the complications were less (LA group 5 cases (1.9%), OA group 36 cases (16.2%),). Conclusion 1 Laparoscopy is safe and effective in the treatment of acute suppurative appendicitis and gangrenous appendicitis. The early operative time of laparoscopic surgery was significantly longer than that of open surgery, and the later operative time was shortened obviously. The total hospitalization cost of patients undergoing laparoscopic appendectomy was higher than that of laparotomy group. The main expenses were new endoscopic technology, high value consumables, general anesthesia, etc. But the cost of postoperative recovery was significantly lower than that of laparotomy group. Laparoscopic appendectomy was one of the ideal methods for the treatment of acute suppurative appendicitis and gangrenous appendicitis, and could be popularized in clinical practice.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.8
【参考文献】
相关期刊论文 前10条
1 刘冰熔;王宏光;孙相钊;叶丽萍;田戬;冯佳;郑东林;杨卓;曲波;殷积彬;王曼彤;叶营;鲁殿荣;王东旭;张靖;冯子坛;麻树人;马骁;;内镜逆行阑尾炎治疗术应用多中心回顾性分析[J];中华消化内镜杂志;2016年08期
2 李登位;周正;;阑尾炎手术方式的微创演变及其进展[J];中日友好医院学报;2015年06期
3 吕挺正;陈功;郑珊;;某医院20年间阴性阑尾切除调查与分析[J];临床小儿外科杂志;2015年03期
4 林俊青;刘春庆;;腹腔镜阑尾切除术中转开腹的临床分析[J];中国医学创新;2015年13期
5 王家亮;葛步军;黄琦;刘黎明;陈清;;免气腹与传统腹腔镜阑尾切除术的随机对照研究[J];中华普通外科杂志;2014年11期
6 陈伟;杨占雷;王红鹏;姚南;;腹腔镜诊断治疗儿童阑尾炎的进展及前景[J];黑龙江医学;2014年03期
7 张伟耀;周霞;;腹腔镜阑尾切除术与开腹阑尾切除术的并发症大样本对比分析[J];中国全科医学;2014年03期
8 郭维;;急性阑尾炎病理分型与超声图像特征的对比分析[J];现代诊断与治疗;2013年20期
9 司宇光;;急性单纯性阑尾炎的保守治疗体会[J];中国医疗前沿;2013年08期
10 王有利;刘凡;叶颖江;申占龙;尹慕军;姜可伟;王杉;;腹腔镜阑尾切除术在急性和慢性阑尾炎中应用疗效的比较[J];中华普通外科杂志;2013年02期
相关博士学位论文 前1条
1 欧鹏;腹腔镜阑尾切除术与开腹阑尾切除术的临床对比研究[D];中南大学;2012年
相关硕士学位论文 前1条
1 李忠;腹腔镜阑尾切除术与开腹阑尾切除术的临床对比研究[D];新疆医科大学;2014年
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