Lin Song,Su Yingchun,Zhou Sihai,et al.Application of enhanced recovery after surgery for perforated appendicitis[J].Journal of Clinical Pediatric Surgery,,18():267-271.[doi:10.3969/j.issn.1671-6353.2019.04.004]
Application of enhanced recovery after surgery for perforated appendicitis
- Keywords:
- Appendicitis/SU; Enhanced Recovery After Surgery; Intraoperative Period; Stress; Laparoscopy
- CLC:
- R493;R729;R574.61
- Abstract:
- Objective To explore the application of enhanced recovery after surgery plus laparoscopic technique in children with perforated appendicitis.Methods Retrospective analyses were performed for 126 cases with perforated appendicitis from August 2015 to August 2018.According to preoperative preparation,anesthesia choice,laparoscopic appendectomy and postoperative treatment,they were divided into study group (n=63) and control group (n=63).Then operative duration,wound infection,abdominal & pelvic abscess formation,recovery of intestinal function,postoperative hospital stay,hospitalization expense and parental satisfaction were compared between two groups.Results The postoperative time of anal exhaust was (16.38±3.45) h in study group versus (22.45±5.32) h in control group.The difference was statistically significant (t=7.985,P<0.001).The recovery time of postoperative bowel sounds and oral feeding time were (9.84±3.48) h and (10.23±1.51) h versus (12.29±4.37) h and (13.46±2.67) h respectively.The differences were statistically significant (P<0.05).In study group,there were incision infection (n=4),abdominal & pelvic abscess (n=2) and no postoperative bleeding or intestinal adhesion; in control group,incision infection (n=6) and abdominal & pelvic abscess (n=1).No significant inter-group difference existed in the incidence of complications (P>0.05).The hospitalization time was (5.34±0.67) days in study group versus (7.46±1.60) days in control group.The difference was statistically significant (t=9.670,P<0.001); hospitalization expense was (7 012.41±246.28) yuan in study group versus (9 321.74±421.49) yuan in control group.The difference was statistically significant (t=36.085,P<0.001).The satisfaction rate of study group was significantly higher than that of control group (92.06% vs 79.36%).The difference was statistically significant (χ2=-4.415,P=0.042).Conclusion The efficacy of enhanced recovery after surgery plus laparoscopic technique is remarkable for children with perforated appendicitis.It offers the advantages of promoting early ingestion,shorter hospitalization time,lower hospitalization expense and greater parental satisfaction.Wider popularization is recommended.
References:
1 Kehlet H.Multimodal approach to control postoperative pathophysiology and rehabilitation[J].Br J Anaesth,1997,78(5):606-617.DOI:10.1093/bja/78.5.606.
2 Ji Y L,Ally S,Kelly B,et al.Once daily dosing of ceftriaxone and metronidazole in children with perforated appendicitis[J].J Pediatr Pharmacol Ther,2016,21(2):140-145.DOI:10.5863/1551-6776-21.2.140.
3 Günaydin M,Demirel D,Bernay F,et al.Laparoscopic appendectomy for perforated appendicitis in children:Is intraperitoneal drainage necessary?[J].Journal of Clinical & Experimental Investigations,2015,6(3):224-227.DOI:10.5799/ahinjs.01.2015.03.0523.
4 蔡宝,徐冰,胡耀宗,等.腹腔镜手术与开腹手术治疗小儿穿孔性阑尾炎的疗效比较研究[J].临床小儿外科杂志,2018,17(3):223-225.DOI:10.3969/j.issn.1671-6353.2018.03.013. Cai B,Xu B,Hu YZ,et al.Comparative study on the postoperative recovery effect of laparoscopic versus open appendectomy in the perforated appendicitis in children[J].J Clin Ped Sur,2018,17(3):223-225.DOI:10.3969/j.issn.1671-6353.2018.03.013.
5 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.
6 Esposito C,Calvo AI,Castagnetti M,et al.Open versus laparoscopic appendectomy in the pediatric population:a literature review and analysis of complications[J].J Laparoendosc Adv Surg Tech A,2012,22(8):834-839.DOI:10.1089/lap.2011.0492.
7 Tanaka S,Kubota D,Lee SH,et al.Effectiveness of laparoscopic approach for acute appendicitis[J].Osaka City Med J,2007,53(1):1-8.
8 中华医学会小儿外科分会内镜外科学组.腹腔镜小儿阑尾切除术操作指南(2017版)[J].中华小儿外科杂志,2017,38(10):725-732.DOI:10.3760/cma.j.issn.0253-3006.2017.10.002. Section of Laparoscopic and Endoscopic Surgery,Branch of Pediatric Surgery,Chinese Medical Association.Operative Guidelines for Pediatric Laparoscopic Appendectomy (2017 Edition)[J].Chin J Pediatr Surg,2017,38(10):725-732.DOI:10.3760/cma.j.issn.0253-3006.2017.10.002.
9 Kawano A,Ogawa E,Furusyo N,et al.Bacterial infection as an adverse effect of telaprevir-based triple therapy for chronic hepatitis C infection[J].Intern Med,2015,54(6):567-572.DOI:10.2169/internalmedicine.54.3457.
10 Osman Zeki Karakus, Ulusoy O,Oguz Ates,et al.Conventional single-port laparoscopic appendectomy for complicated appendicitis in children:Efficient and cost-effective[J].J Minim Access Surg,2016,12(1):16-21.DOI:10.4103/0972-9941.171958.
11 Groves LB,Ladd MR,Gallaher JR,et al.Comparing the cost and outcomes of laparoscopic versus open appendectomy for perforated appendicitis in children[J].Am Surg,2013,79(9):861-864.DOI:10.1186/1477-7819-11-217.
12 张瑜,张苗,邓立华,等.阑尾炎穿孔患儿腹腔镜手术后相关感染的临床分析[J].中华医院感染学杂志,2016,26(15):3569-3571.DOI:10.11816/cn.ni.2016-154246. Zhan Y,Zhang M,Deng LH,et al.Clinical analysis of postoperative infection in children with perforated appendicitis after laparoscopic operation[J].Chin J Nosocomiol,2016,26(15):3569-3571.DOI:10.11816/cn.ni.2016-154246.
13 李乐,李鑫,景化忠,等.腹腔镜手术治疗坏疽及穿孔性阑尾炎的探讨[J].中国普外基础与临床杂志,2015,22(7):828-831.DOI:10.7507/1007-9424.20150213. Li L,Li X,Jing HZ,et al.Investigate the laparoscopic operation for treatment gangrenous and perforated appendicitis[J].Chin J Bases Clin General Surg,2015,22(7):828-831.DOI:10.7507/1007-9424.20150213.
14 Perea L,Peranteau WH,Laje P.Transumbilical extracorporeal laparoscopic-assisted appendectomy[J].J.Pediatr Surg,2018,53(2):256.DOI:10.1016/j.jpedsurg.2017.11.012.
15 Scirè G,Mariotto A,Peretti M,et al.Laparoscopic versus open appendectomy in the management of acute appendicitis in children:a multicenter retrospective study[J].Minerva Pediatr,2014,66(4):281-285.
16 Guana R,Lonati L,Garofalos,et al.Lapamscopic versus open surgery in complicated apperldicitis in children 1ess than 5 years old:a six-year single-center experience[J].Surg Res Pract,2016,2016:4120214.DOI:10.1155/2016/4120214.
17 Castagnetti M,Cimador M,Grazia ED.Duodenal perforation due to an abdominal drain placed after appendectomy in a child[J].Pediatr Med Chir,2008,30(2):99-101.
18 Ezer A,Nurkan Törer,Kenan Caliskan,et al.Use of drainage in surgery for perforated appendicitis:the effect on complications[J].Ulus Travma Acil Cerrahi Derg,2010,16(5):427-32.DOI:10.1016/j.resuscitation.2010.06.001.
19 Tomecka MJ,Bortsov AV,Miller NR,et al.Substantial postoperative pain is common among children undergoing laparoscopic appendectomy[J].Paediatr Anaesth,2012,22(2):130-135.DOI:10.1111/j.1460-9592.2011.03711.x.
Memo
收稿日期:2019-01-14。
作者简介:林松,Email:2940177295@qq.com