65岁以上急性阑尾炎患者腹腔镜术后并发症的临床研究
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摘要
目的分析65岁以上急性阑尾炎患者经腹腔镜和开腹阑尾切除术后并发症的发生率及治疗策略。方法选取重庆市綦江区心新医院2010年1月至2015年12月收治的65岁以上行急性阑尾炎手术切除患者168例为研究对象。按手术方式分为腹腔镜组(LA组)和开腹手术组(OA组)。比较两种术式手术时间、术中出血量、患者下床活动时间、住院时间和术后并发症发生率。结果 LA组患者的手术时间、术中出血量、下床活动时间、住院时间、切口愈合不良和粘连性肠梗阻的发生率明显少于OA组患者,差异具有统计学意义(P <0. 05)。结论 65岁以上老年急性阑尾炎患者行腹腔镜阑尾切除术并发症发生率较低,恢复快,但术前应准确评估,根据患者情况选择,避免术后发生并发症。
Objective To analyze the incidence of postoperative complications and treatment strategies of laparoscopic appendectomy and conventional open appendectomy for patients over 65 years old. Methods A total of 65 patients with acute appendicitis in Xinxin hospital of Qijiang from January 2010 to December 2015 were selected as object,who were divided into laparoscopic appendectomy( LA) group and open appendectomy( OA) group according to surgical methods. The operative time,blood loss,postoperative ambulation time,hospitalization and rate of postoperative complication between two groups were compared. Results The operative time,blood loss,time of post-operative activity out of bed,hospitalization and rate of poor wound healing and adhesive intestinal obstruction in LA group were lower than those in OA group,the differences were significant( P < 0. 05). Conclusion Laparoscopic appendectomy has the advantages of low incidence of complication and rapid recovery for patients with acute appendicitis over 65 years old,therefore,the individualized treatment strategy should be selected according to preoperative evaluation of patients to avoid postoperative complication.
Objective To analyze the incidence of postoperative complications and treatment strategies of laparoscopic appendectomy and conventional open appendectomy for patients over 65 years old. Methods A total of 65 patients with acute appendicitis in Xinxin hospital of Qijiang from January 2010 to December 2015 were selected as object,who were divided into laparoscopic appendectomy( LA) group and open appendectomy( OA) group according to surgical methods. The operative time,blood loss,postoperative ambulation time,hospitalization and rate of postoperative complication between two groups were compared. Results The operative time,blood loss,time of post-operative activity out of bed,hospitalization and rate of poor wound healing and adhesive intestinal obstruction in LA group were lower than those in OA group,the differences were significant( P < 0. 05). Conclusion Laparoscopic appendectomy has the advantages of low incidence of complication and rapid recovery for patients with acute appendicitis over 65 years old,therefore,the individualized treatment strategy should be selected according to preoperative evaluation of patients to avoid postoperative complication.
引文
[1]白顺滟,魏娜,肖思洁,等.老年急性阑尾炎的临床特征[J].中国中西医结合消化杂志,2014,22(6):316-318.doi:10.3969/j.issn.1671-038X.2014.06.09.
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[4]赵民学,朱琳叶,洪珊,等.单孔腹腔镜阑尾切除术治疗老年急性阑尾炎的疗效[J].中国老年学杂志,2015,35(24):7126-7127.doi:10.3969/j.issn.1005-9202.2015.24.072.
[5]许正金.老年急性阑尾炎临床特点及诊治分析[J].基层医学论坛,2013,17(23):3006-3007.doi:10.3969/j.issn.1672-1721.2013.23.011.
[6]Gasior AC,St Peter SD,Knott EM,et al.National trends in approach and outcomes with appendicitis in children[J].J Pediatr Surg,2012,47(12):2264-2267.doi:10.1016/j.jpedsurg.2012.09.019.
[7]Lintula H,Kokki H,Vanamo K,et al.Laparoscopy in children with complicated appendicitis[J].J Pediatr Surg,2002,37(9):1317-1320.doi:10.1053/jpsu.2002.34998.
[8]Esposito C,Borzi P,Valla JS,et al.Laparoscopic versus open appendectomy in children:a retrospective comparative study of 2,332 cases[J].World J Surg,2007,31(4):750-755.doi:10.1007/s00268-006-0699-8.
[9]Tsao KJ,St Peter SD,Valusek PA,et al.Adhesive small bowel obstruction after appendectomy in children:comparison between the laparoscopic and open approach[J].J Pediatr Surg,2007,42(6):939-942.doi:10.1016/j.jpedsurg.2007.01.025.
[10]Becker P,Fichtner-Feigl S,Schilling D.Operative management of appendicitis[J].Visc Med,2018,34(6):453-458.doi:10.1159/000494883.
[11]张庆鹏,卫勃,陈凛.腹腔镜在65岁以上胃肠外科急腹症患者手术中的应用[J].中华胃肠外科杂志,2015,18(8):797-800.doi:10.3760/cma.j.issn.1671-0274.2015.08.021.
[2]Horvath P,Lange J,Bachmann R,et al.Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis.[J].Surg Endosc,2017,31(1):199-205.doi:10.1007/s00464-016-4957-z.
[3]刘长昆,王建,于世良,等.腹腔镜与开腹手术治疗老年急性阑尾炎患者的疗效对比分析[J].中国普外基础与临床杂志,2011,18(7):766-768.
[4]赵民学,朱琳叶,洪珊,等.单孔腹腔镜阑尾切除术治疗老年急性阑尾炎的疗效[J].中国老年学杂志,2015,35(24):7126-7127.doi:10.3969/j.issn.1005-9202.2015.24.072.
[5]许正金.老年急性阑尾炎临床特点及诊治分析[J].基层医学论坛,2013,17(23):3006-3007.doi:10.3969/j.issn.1672-1721.2013.23.011.
[6]Gasior AC,St Peter SD,Knott EM,et al.National trends in approach and outcomes with appendicitis in children[J].J Pediatr Surg,2012,47(12):2264-2267.doi:10.1016/j.jpedsurg.2012.09.019.
[7]Lintula H,Kokki H,Vanamo K,et al.Laparoscopy in children with complicated appendicitis[J].J Pediatr Surg,2002,37(9):1317-1320.doi:10.1053/jpsu.2002.34998.
[8]Esposito C,Borzi P,Valla JS,et al.Laparoscopic versus open appendectomy in children:a retrospective comparative study of 2,332 cases[J].World J Surg,2007,31(4):750-755.doi:10.1007/s00268-006-0699-8.
[9]Tsao KJ,St Peter SD,Valusek PA,et al.Adhesive small bowel obstruction after appendectomy in children:comparison between the laparoscopic and open approach[J].J Pediatr Surg,2007,42(6):939-942.doi:10.1016/j.jpedsurg.2007.01.025.
[10]Becker P,Fichtner-Feigl S,Schilling D.Operative management of appendicitis[J].Visc Med,2018,34(6):453-458.doi:10.1159/000494883.
[11]张庆鹏,卫勃,陈凛.腹腔镜在65岁以上胃肠外科急腹症患者手术中的应用[J].中华胃肠外科杂志,2015,18(8):797-800.doi:10.3760/cma.j.issn.1671-0274.2015.08.021.