腹腔镜阑尾切除术和开腹阑尾切除术的效果和成本比较
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摘要
目的比较腹腔镜阑尾切除术(LA)与开腹阑尾切除(OA)治疗阑尾炎的效果和成本,分析两者的差异原因。方法回顾性分析2014年1月~2016年11月期间的首都医科大学宣武医院门诊和急诊的495例阑尾炎患者的资料,根据治疗方式不同,将患者分为LA组(实验组,n=441)和OA组(对照组,n=54)。比较两组患者年龄、性别、麻醉分级(ASA)、手术时间、住院时间、抗生素使用时间和总费用等。结果实验组术后住院时间短于对照组,差异有高度统计学意义(P <0.01);实验组手术时间短于对照组,差异有高度统计学意义(P <0.01)。抗生素使用时间实验组短于对照组,差异有高度统计学意义(P <0.01)。实验组术中出血量少于对照组出血量时间,差异有高度统计学意义(P <0.01)。两组总费用比较,差异无统计学意义(P> 0.05)。结论 LA是一种安全、有效的阑尾切除术手术方法,与OA比较,缩短了住院时间、手术时间和抗生素使用时间,出血量少,可作为阑尾炎和腹痛患者的标准治疗方法。
Objective To compare the effects and costs of laparoscopic appendectomy(LA) and open appendectomy(OA) in treating appendicitis, and analyze the reasons for the differences. Methods The data of 495 cases of appendicitis in the Outpatient and Emergency Department of Xuanwu Hospital of Capital Medical University from January 2014 to November 2016 were retrospectively analyzed, according to different treatment methods, patients were divided into LA group(experimental group, n = 441) and OA group(control group, n = 54). Age, sex, anesthesia classification(ASA), operation time, hospitalization time, antibiotic use time and total cost were compared between the two groups.Results The length of stay in the LA group was shorter than the control group, and the difference was highly statistically significant(P < 0.01). The operation time of experimental group was significantly shorter than that of control group,and the difference was highly statistically significant(P < 0.01). The time of antibiotic treatment in experimental group was shorter than that in control group, and the difference was highly statistically significant(P < 0.01). The intraoperative blood loss in experimental group was less than that in control group, the difference was highly statistically significant(P < 0.01). There was no statistically significant difference in total cost between the two groups(P > 0.05). Conclusion LA is a safe and effective surgical method for appendectomy. Compared with OA, LA shortens hospital stay, operation time and antibiotic use time, and reduces blood loss. LA may be the standard treatment for patients with appendicitis and abdominal pain.
Objective To compare the effects and costs of laparoscopic appendectomy(LA) and open appendectomy(OA) in treating appendicitis, and analyze the reasons for the differences. Methods The data of 495 cases of appendicitis in the Outpatient and Emergency Department of Xuanwu Hospital of Capital Medical University from January 2014 to November 2016 were retrospectively analyzed, according to different treatment methods, patients were divided into LA group(experimental group, n = 441) and OA group(control group, n = 54). Age, sex, anesthesia classification(ASA), operation time, hospitalization time, antibiotic use time and total cost were compared between the two groups.Results The length of stay in the LA group was shorter than the control group, and the difference was highly statistically significant(P < 0.01). The operation time of experimental group was significantly shorter than that of control group,and the difference was highly statistically significant(P < 0.01). The time of antibiotic treatment in experimental group was shorter than that in control group, and the difference was highly statistically significant(P < 0.01). The intraoperative blood loss in experimental group was less than that in control group, the difference was highly statistically significant(P < 0.01). There was no statistically significant difference in total cost between the two groups(P > 0.05). Conclusion LA is a safe and effective surgical method for appendectomy. Compared with OA, LA shortens hospital stay, operation time and antibiotic use time, and reduces blood loss. LA may be the standard treatment for patients with appendicitis and abdominal pain.
引文
[1] Saverio DS,Mandrioli M,Birindelli A,et al. Single-incision laparoscopic appendectomy with a low-cost technique and surgical-glove port:“how to do it” with comparison of the outcomes and costs in a consecutive single-operator series of 45 cases[J]. J Am Coll Surg,2016,222(3):e15-e30.
[2] Saverio DS. Emergency laparoscopy:a new emerging discipline for treating abdominal emergencies attempting to minimize costs and invasiveness and maximize outcomes and patients′comfort[J]. J Trauma Acute Care Surg,2014,77(2):338-350.
[3] Garbutt JM,Soper NJ,Shannon WD,et al. Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy[J]. Surg Laparosc Endosc,1999,9(1):17-26.
[4] Fogli L,Brulatti M,Boschi S,et al. Laparoscopic appendectomy for acute and recurrent appendicitis:retrospective analysis of a single-group 5-year experience[J]. J Laparoendosc Adv Surg Tech,2002,12(2):107-110.
[5] Towfigh S,Chen F,Mason R,et al. Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis[J]. Surg Endosc,2006,20(3):495-499.
[6] Milewczyk M,Michalik M,Ciesielski M. A prospective,randomized,unicenter study comparing laparoscopic and open treatments of acute appendicitis[J]. Surg Endosc,2003,17(7):1023-1028.
[7] Olmi S,Magnone S,Bertolini A,et al. Laparoscopic versus open appendectomy in acute appendicitis:a randomized prospective study[J]. Surg Endosc,2005,19(9):1193-1195.
[8] Shaikh AR,Sangrasi AK,Shaikh GA. Clinical Outcomes of Laparoscopic Versus Open Appendectomy[J]. JSlS,2009,13(4):574-580.
[9] Agresta F,De Simone P,Leone L,et al. Laparoscopic appendectomy in Italy:an appraisal of 26,863 cases[J]. J Laparoendosc Adv Surg Tech,2004,14(1):1-8.
[10] Saverio DS,Mandrioli M,Sibilio A,et al. A cost-effective technique for laparoscopic appendectomy:outcomes and costs of a case-control prospective single-operator study of 112 unselected consecutive cases of complicated acute appendicitis[J]. J Am Coll Surg,2014,218(3):e51-e65.
[11] Kurtz RJ,Heimann TM. Comparison of open and laparoscopic treatment of acute appendicitis[J]. Am J Surg,2001,182(3):211-214.
[12] Katkhouda N,Mason RJ,Towfigh S,et al. Laparoscopic versus open appendectomy:a prospective randomized double-blind study[J]. Ann Surg,2005,242(3):439-450.
[13] Ignacio RC,Burke R,Spencer D,et al. Laparoscopic versus open appendectomy:what is the real difference? Results of a prospective randomized double-blinded trial[J].Surg Endosc,2004,18(2):334-337.
[14] Kehagias I,Karamanakos SN,Panagiotopoulos S,et al. Laparoscopic versus open appendectomy:which way to go?[J].WJG,2008,14(31):4909-4914.
[15]王金洪.腹腔镜阑尾切除术与开腹阑尾切除术疗效比较[J].中国保健营养,2018,28(33):96.
[16]郑岩.腹腔镜手术治疗阑尾炎的效果分析[J].中国现代药物应用,2017,11(24):24-25.
[17]薛兆强,唐文东,刘涛,等.腹腔镜和开腹手术治疗小儿急性阑尾炎临床疗效分析[J].临床外科杂志,2017,25(9):676-677.
[18]张武坤,田绍昆,贺晓霞,等.腹腔镜手术与开腹手术治疗成人急性阑尾炎的对比研究[J].中国处方药,2015,13(5):109-110.
[19]李志超.腹腔镜与开腹手术治疗成人急性阑尾炎的疗效及安全性分析[J].中国实用医药,2016,11(1):49-50.
[20]郭婧,刘勇峰,袁江涛,等.腹腔镜阑尾切除与开腹阑尾切除术疗效比较[J].中国现代普通外科进展,2018,21(9):721-723.
[21]曾达.腹腔镜阑尾切除体会[J].医药前沿,2018,8(32):66.
[2] Saverio DS. Emergency laparoscopy:a new emerging discipline for treating abdominal emergencies attempting to minimize costs and invasiveness and maximize outcomes and patients′comfort[J]. J Trauma Acute Care Surg,2014,77(2):338-350.
[3] Garbutt JM,Soper NJ,Shannon WD,et al. Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy[J]. Surg Laparosc Endosc,1999,9(1):17-26.
[4] Fogli L,Brulatti M,Boschi S,et al. Laparoscopic appendectomy for acute and recurrent appendicitis:retrospective analysis of a single-group 5-year experience[J]. J Laparoendosc Adv Surg Tech,2002,12(2):107-110.
[5] Towfigh S,Chen F,Mason R,et al. Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis[J]. Surg Endosc,2006,20(3):495-499.
[6] Milewczyk M,Michalik M,Ciesielski M. A prospective,randomized,unicenter study comparing laparoscopic and open treatments of acute appendicitis[J]. Surg Endosc,2003,17(7):1023-1028.
[7] Olmi S,Magnone S,Bertolini A,et al. Laparoscopic versus open appendectomy in acute appendicitis:a randomized prospective study[J]. Surg Endosc,2005,19(9):1193-1195.
[8] Shaikh AR,Sangrasi AK,Shaikh GA. Clinical Outcomes of Laparoscopic Versus Open Appendectomy[J]. JSlS,2009,13(4):574-580.
[9] Agresta F,De Simone P,Leone L,et al. Laparoscopic appendectomy in Italy:an appraisal of 26,863 cases[J]. J Laparoendosc Adv Surg Tech,2004,14(1):1-8.
[10] Saverio DS,Mandrioli M,Sibilio A,et al. A cost-effective technique for laparoscopic appendectomy:outcomes and costs of a case-control prospective single-operator study of 112 unselected consecutive cases of complicated acute appendicitis[J]. J Am Coll Surg,2014,218(3):e51-e65.
[11] Kurtz RJ,Heimann TM. Comparison of open and laparoscopic treatment of acute appendicitis[J]. Am J Surg,2001,182(3):211-214.
[12] Katkhouda N,Mason RJ,Towfigh S,et al. Laparoscopic versus open appendectomy:a prospective randomized double-blind study[J]. Ann Surg,2005,242(3):439-450.
[13] Ignacio RC,Burke R,Spencer D,et al. Laparoscopic versus open appendectomy:what is the real difference? Results of a prospective randomized double-blinded trial[J].Surg Endosc,2004,18(2):334-337.
[14] Kehagias I,Karamanakos SN,Panagiotopoulos S,et al. Laparoscopic versus open appendectomy:which way to go?[J].WJG,2008,14(31):4909-4914.
[15]王金洪.腹腔镜阑尾切除术与开腹阑尾切除术疗效比较[J].中国保健营养,2018,28(33):96.
[16]郑岩.腹腔镜手术治疗阑尾炎的效果分析[J].中国现代药物应用,2017,11(24):24-25.
[17]薛兆强,唐文东,刘涛,等.腹腔镜和开腹手术治疗小儿急性阑尾炎临床疗效分析[J].临床外科杂志,2017,25(9):676-677.
[18]张武坤,田绍昆,贺晓霞,等.腹腔镜手术与开腹手术治疗成人急性阑尾炎的对比研究[J].中国处方药,2015,13(5):109-110.
[19]李志超.腹腔镜与开腹手术治疗成人急性阑尾炎的疗效及安全性分析[J].中国实用医药,2016,11(1):49-50.
[20]郭婧,刘勇峰,袁江涛,等.腹腔镜阑尾切除与开腹阑尾切除术疗效比较[J].中国现代普通外科进展,2018,21(9):721-723.
[21]曾达.腹腔镜阑尾切除体会[J].医药前沿,2018,8(32):66.