腹腔镜阑尾切除术治疗急性阑尾炎的效果
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摘要
目的探讨腹腔镜与开腹阑尾切除术治疗急性阑尾炎的临床疗效及对机体炎症反应的影响。方法回顾性分析2015年1月至2018年6月收治的235例急性阑尾炎的临床资料,根据手术方式分为观察组(行腹腔镜手术,n=121)和对照组(行开腹手术,n=114)。对两组患者切口长度、术中出血量、手术时间、肛门首次排气时间、疼痛视觉模拟评分(VAS)、下床活动时间、恢复饮食时间、住院时间以及炎症相关指标等进行比较。结果观察组患者术中出血量、切口长度、手术时间、术后下床活动时间、VAS评分、肛门首次排气时间、恢复饮食时间和住院时间均显著少于对照组,差异有统计学意义(P<0.01)。观察组切口感染率和并发症总发生率均显著低于对照组(P<0.05,P<0.01)。两组患者术后1、3、5 d观察组血清C-反应蛋白(CRP)、白介素-6(IL-6)水平均低于对照组(P<0.01)。结论腹腔镜阑尾切除治疗急性阑尾炎安全有效,对术后机体炎症反应的不良影响较小,患者恢复快,可作为阑尾手术治疗的首选。
Objective To explore the clinical efficacy of laparoscopic appendectomy(LA) and open appendectomy(OA) in the treatment of acute appendicitis and its impact on the body's inflammatory response.Methods The clinical data of 235 cases of acute appendicitis admitted to hospital from January 2015 to June 2018 were analyzed retrospectively.According to the surgical approach,the patients were divided into observation group(receiving LA,n=121)and control group(OA,n=114).The incision length,intraoperative bleeding volume,operation time,first exhaust time of anus,score of visual analogue scale(VAS),time of getting out of bed and restoring diet,hospital stay and related indicators of inflammation were compared between two groups.Results The ntraoperative bleeding volume,incision length,operation time,time of getting out of bed,VAS score,time of first anal exhaust and restoring diet,hospital stay in observation group were significantly lower than those in control group(all P<0.01).The incision infection rate and the total incidence of complications in observation group were significantly lower than those in control group(P<0.05,P<0.01).Compared with control group,the levels of C-reactive protein(CRP) and interleukin-6(IL-6) statistically decreased at postoperative 1-,3-and 5-day in observation group(all P<0.01).Conclusions Laparoscopic appendectomy is safe and effective in the treatment of acute appendicitis.It has less adverse effect on the body inflammatory reaction after operation and can be considered as the first choice for appendectomy.
Objective To explore the clinical efficacy of laparoscopic appendectomy(LA) and open appendectomy(OA) in the treatment of acute appendicitis and its impact on the body's inflammatory response.Methods The clinical data of 235 cases of acute appendicitis admitted to hospital from January 2015 to June 2018 were analyzed retrospectively.According to the surgical approach,the patients were divided into observation group(receiving LA,n=121)and control group(OA,n=114).The incision length,intraoperative bleeding volume,operation time,first exhaust time of anus,score of visual analogue scale(VAS),time of getting out of bed and restoring diet,hospital stay and related indicators of inflammation were compared between two groups.Results The ntraoperative bleeding volume,incision length,operation time,time of getting out of bed,VAS score,time of first anal exhaust and restoring diet,hospital stay in observation group were significantly lower than those in control group(all P<0.01).The incision infection rate and the total incidence of complications in observation group were significantly lower than those in control group(P<0.05,P<0.01).Compared with control group,the levels of C-reactive protein(CRP) and interleukin-6(IL-6) statistically decreased at postoperative 1-,3-and 5-day in observation group(all P<0.01).Conclusions Laparoscopic appendectomy is safe and effective in the treatment of acute appendicitis.It has less adverse effect on the body inflammatory reaction after operation and can be considered as the first choice for appendectomy.
引文
[1] 陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2015:385-391.
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[3] Dai LP,Shuai J.Laparoscopic versus open appendectomy in adults and children:a meta-analysis of randomized controlled trials[J].United European Gastroenterol J,2017,5(4):542-553.
[4] 姜笑明,黄文海,俞建平.腹腔镜阑尾切除术与开腹阑尾切除术的对比研究[J].复旦学报(医学版),2018,45(2):221-226.
[5] Shimoda M,Maruyama T,Nishida K,et al.Comparison of clinical outcome of laparoscopic versus open appendectomy,single center experience[J].Heliyon,2018,4(5):e00635.
[6] 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.
[7] 刘坤鹏,邢宝平,王明治,等.腹腔镜与开腹胆囊切除治疗急性结石性胆囊炎的临床分析[J].中华普外科手术学杂志(电子版),2018,12(3):250-253.
[8] Ruiz-Patiňo A,Rey S,Molina G,et al.Cost-effectiveness of laparoscopic versus open appendectomy in developing nations:a Colombian analysis[J].J Surg Res,2018,224:33-37.
[9] 肖思建,李鹏宇,张雷,等.腹腔镜阑尾切除术与开腹阑尾切除术的对比研究[J].腹腔镜外科杂志,2015,20(5):384-386.
[10] Adamina M,Steffen T,Tarantino I,et al.Meta-analysis of the predictive value of C-reactive protein for infectious complications in abdominal surgery[J].Br J Surg,2015,102(6):590-598.
[11] 马治贫.腹腔镜手术治疗与开腹手术治疗对急性化脓性阑尾炎患者免疫球蛋白及细胞因子的影响[J].黑龙江医药,2017,30(1):177-179.
[12] 朱峰毅,查秀芳,张国新,等.内镜逆行性阑尾炎治疗术治疗急性阑尾炎的历史、现状与进展[J].中国临床研究,2018,31(1):131-133.
[13] 钟春林,刘文,向荣超,等.腹腔镜阑尾切除术4450例分析[J].临床外科杂志,2017,25(6):448-449.
[14] 苏洲,姚寒晖,夏猛,等.腹腔镜和开腹手术治疗急性阑尾炎的临床疗效和安全性分析[J].中华全科医学,2017,15(7):1150-1152,1165.
[15] 朱峰毅,查秀芳,张国新,等.内镜逆行性阑尾炎治疗术治疗急性阑尾炎的历史、现状与进展[J].中国临床研究,2018,31(1):131-133.
[16] 苏洲,姚寒晖,夏猛,等.腹腔镜和开腹手术治疗急性阑尾炎的临床疗效和安全性分析[J].中华全科医学,2017,15(7):1150-1152,1165.
[2] Kumar S,Jalan A,Patowary BN,et al.Laparoscopic appendectomy versus open appendectomy for acute appendicitis:a prospective comparative study[J].Kathmandu Univ Med J (KUMJ),2016,14(55):244-248.
[3] Dai LP,Shuai J.Laparoscopic versus open appendectomy in adults and children:a meta-analysis of randomized controlled trials[J].United European Gastroenterol J,2017,5(4):542-553.
[4] 姜笑明,黄文海,俞建平.腹腔镜阑尾切除术与开腹阑尾切除术的对比研究[J].复旦学报(医学版),2018,45(2):221-226.
[5] Shimoda M,Maruyama T,Nishida K,et al.Comparison of clinical outcome of laparoscopic versus open appendectomy,single center experience[J].Heliyon,2018,4(5):e00635.
[6] 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.
[7] 刘坤鹏,邢宝平,王明治,等.腹腔镜与开腹胆囊切除治疗急性结石性胆囊炎的临床分析[J].中华普外科手术学杂志(电子版),2018,12(3):250-253.
[8] Ruiz-Patiňo A,Rey S,Molina G,et al.Cost-effectiveness of laparoscopic versus open appendectomy in developing nations:a Colombian analysis[J].J Surg Res,2018,224:33-37.
[9] 肖思建,李鹏宇,张雷,等.腹腔镜阑尾切除术与开腹阑尾切除术的对比研究[J].腹腔镜外科杂志,2015,20(5):384-386.
[10] Adamina M,Steffen T,Tarantino I,et al.Meta-analysis of the predictive value of C-reactive protein for infectious complications in abdominal surgery[J].Br J Surg,2015,102(6):590-598.
[11] 马治贫.腹腔镜手术治疗与开腹手术治疗对急性化脓性阑尾炎患者免疫球蛋白及细胞因子的影响[J].黑龙江医药,2017,30(1):177-179.
[12] 朱峰毅,查秀芳,张国新,等.内镜逆行性阑尾炎治疗术治疗急性阑尾炎的历史、现状与进展[J].中国临床研究,2018,31(1):131-133.
[13] 钟春林,刘文,向荣超,等.腹腔镜阑尾切除术4450例分析[J].临床外科杂志,2017,25(6):448-449.
[14] 苏洲,姚寒晖,夏猛,等.腹腔镜和开腹手术治疗急性阑尾炎的临床疗效和安全性分析[J].中华全科医学,2017,15(7):1150-1152,1165.
[15] 朱峰毅,查秀芳,张国新,等.内镜逆行性阑尾炎治疗术治疗急性阑尾炎的历史、现状与进展[J].中国临床研究,2018,31(1):131-133.
[16] 苏洲,姚寒晖,夏猛,等.腹腔镜和开腹手术治疗急性阑尾炎的临床疗效和安全性分析[J].中华全科医学,2017,15(7):1150-1152,1165.