腹腔镜手术与开腹手术治疗复杂性阑尾炎的临床疗效研究

发布时间：2018-09-18 14:25

【摘要】：目的:探讨开腹手术及腹腔镜手术治疗复杂性阑尾炎的优缺点,为临床合理选择手术方式提供依据。方法:本课题回顾性收集分析皖南医学院第一附属医院2012-2014年复杂性阑尾炎病例,共有160例患者术后诊断为复杂性阑尾炎,符合纳入诊断标准,此中腹腔镜阑尾切除术(Laparoscopic appendectomy,LA)组含有65例,传统开腹阑尾切除术(open appendectomy,OA)组95例,其中有4例初为腹腔镜探查后无法顺利完成手术,后中转开腹手术。通过比较对比分析,患者年龄,性别,发病时间至手术时间、血白细胞计数、中性粒细胞比例、病理分型、腹腔脓液量、腹腔冲洗率、腹腔引流率、手术时间、术中出血、切口长度、肛门排气时间、下床活动时间、住院费用、住院时间、以及术后并发症(切口感染或穿刺孔感染、肺部感染、腹腔脓肿、肠梗阻、肠瘘、出血等)的发生率。结果:LA组及OA组的年龄、性别、术前WBC、N计数、病理分型、腹腔脓液量、腹腔引流率、手术时间、肺部感染发生率、肠梗阻发生率、腹腔脓肿发生率、住院费用等差异均无统计学差异(P0.05)。LA组及OA组腹腔冲洗率分别为100%、23.1%,LA组腹腔冲洗率明显高于OA组,两组差异有统计学意义(P0.05)。术中出血分别为31.2±21.4ml、45.2±38.1ml,OA组术中出血量高于LA组,差异有统计学意义(P0.05)。手术切口长度分别为2.2±0.5cm、6.3±2.4cm,OA组手术切口长度长于LA组,差异有统计学意义(P0.05)。LA组及OA组下床活动时间分别为2.29±0.98d、2.91±0.75d,LA组术后下床活动时间较OA组早,差异有统计学意义(P0.05)。肛门通气时间分别为2.22±1.07d、2.75±0.84d,LA组术后肛门排气时间较OA组早,差异有统计学意义(P0.05)。住院时间分别为7.26±3.16d、8.55±4.85d,LA组术后住院时间短语OA组,差异有统计学意义(P0.05)。术后总并发症发生率分别为4.9%、16.8%,OA组术后并发症发生率高于LA组,差异有统计学意义(P0.05)。并发症切口感染(穿刺孔感染)分别为1.6%、10.5%,LA组术后切口感染率低于OA组,差异有统计学意义(P0.05)。结论:LA与OA相比,具有创伤小、恢复快、术后并发症少、住院时间短等优点,在治疗复杂性阑尾炎方面,LA可能是一种有效的、安全的手术方式。
[Abstract]:Objective: to explore the advantages and disadvantages of laparotomy and laparoscopic surgery in the treatment of complicated appendicitis, and to provide the basis for the rational selection of surgical methods. Methods: the patients with complicated appendicitis in the first affiliated Hospital of Southern Anhui Medical College from 2012 to 2014 were retrospectively collected and analyzed. A total of 160 patients were diagnosed as complicated appendicitis after operation, which met the criteria of inclusion diagnosis. There were 65 cases in laparoscopic appendectomy (Laparoscopic appendectomy,LA) group and 95 cases in traditional open appendectomy (open appendectomy,OA) group. Age, sex, onset time to operation time, leukocyte count, neutrophil ratio, pathological classification, peritoneal empyema, celiac irrigation rate, celiac drainage rate, operative time, intraoperative bleeding were compared and analyzed. Length of incision, time of anal exhaust, time of getting out of bed, cost of hospitalization, hospital stay, and incidence of postoperative complications (incision infection or puncture hole infection, pulmonary infection, abdominal abscess, intestinal obstruction, intestinal fistula, bleeding, etc.). Results the age, sex, preoperative WBC,N count, pathological classification, celiac empyema, celiac drainage rate, operative time, pulmonary infection rate, intestinal obstruction rate, abdominal abscess rate, the age, sex, preoperative WBC,N count, pathological type, intraperitoneal drainage rate, lung infection rate, intestinal obstruction rate, abdominal abscess rate of the two groups were analyzed. There was no significant difference in hospitalization expenses between LA group and OA group (P 0.05). The celiac lavage rate of LA group was significantly higher than that of OA group (P 0.05). Intraoperative bleeding was 31.2 卤21.4 ml / ml and 45.2 卤38.1 ml / ml respectively in OA group, which was significantly higher than that in LA group (P0.05). The operative incision length in OA group was 2.2 卤0.5 cm ~ (-1) 卤2.4 cm ~ (-1) respectively, which was longer than that in LA group (P0.05). The time of getting out of bed in LA group and OA group was 2.29 卤0.98 days and 2.91 卤0.75 days after operation, respectively, which was significantly earlier than that in OA group (P0.05). The anal ventilation time of LA group was 2.22 卤1.07d and 2.75 卤0.84d respectively, which was earlier than that of OA group (P0.05). The hospitalization time of LA group was 7.26 卤3.16 days and 8.55 卤4.85 days after operation respectively, the difference was statistically significant (P0.05). The incidence of postoperative complications in the OA group was higher than that in the LA group (P 0.05). The postoperative infection rate of incision infection (puncture hole infection) in the complications group (1.6%) was significantly lower than that in the OA group (P0.05). Conclusion compared with OA, Ve-LA has the advantages of less trauma, faster recovery, less postoperative complications and shorter hospital stay. It may be an effective and safe surgical method in the treatment of complicated appendicitis.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.8

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