Shen Yang,Zhuo Baobiao,Sun Qingzeng.Efficacy of laparoscopic-assisted appendectomy versus laparotomy of pediatric appendicitis with different pathological types[J].Journal of Clinical Pediatric Surgery,2019,18(09):784-788.[doi:10.3969/j.issn.1671-6353.2019.09.016]
腹腔镜和开放手术治疗不同病理类型小儿阑尾炎的疗效分析
- Title:
- Efficacy of laparoscopic-assisted appendectomy versus laparotomy of pediatric appendicitis with different pathological types
- Keywords:
- Laparoscopes; Appendicitis; Child
- 分类号:
- R726.1;R574.61
- 摘要:
- 目的 比较腹腔镜与开腹手术治疗不同病理类型小儿阑尾炎的疗效。方法 回顾性分析2009年1月至2013年12月徐州医科大学附属徐州儿童医院经术后病理证实为阑尾炎的362例住院患儿的临床资料（包括单纯阑尾炎92例、化脓性阑尾炎184例、坏疽性阑尾炎86例），按手术方式将不同病理类型的阑尾炎患儿分为腹腔镜辅助下阑尾切除组（LA组）和开腹手术组（OA组），统计各组术后并发症的发生情况。结果 单纯性阑尾炎LA组出现肠梗阻2例（4.3%），OA组出现肠梗阻9例（19.6%），差异有统计学意义（P<0.05）；LA组出现切口感染1例（2.2%）；OA组出现切口感染8例（17.4%），差异有统计学意义（P<0.05）。化脓性阑尾炎LA组出现肠梗阻5例（6.0%），OA组出现肠梗阻14例（14.0%），差异没有统计学意义（P>0.05）；LA组出现切口感染5例（6.0%），OA组出现切口感染12例（12.0%），差异没有统计学意义（P>0.05）。坏疽性阑尾炎LA组出现肠梗阻3例（6%），OA组出现肠梗阻4例（8.7%），差异没有统计学意义（P>0.05）；LA组出现切口感染5例（10%），OA组出现切口感染12例（12%），差异没有统计学意义（P>0.05）。结论 单纯性阑尾炎采用腹腔镜辅助下阑尾切除的治疗效果相对更好，但化脓性阑尾和坏疽性阑尾炎术后并发症的发生与选择何种术式的关系不大。
- Abstract:
- Objective To explore the efficacy of laparoscopic-assisted appendectomy versus laparotomy of pediatric appendicitis with different pathological types.Methods Retrospective analysis was performed for 362 hospitalized appendicitis children from January in 2009 to December in 2013.They were confirmed by postoperative pathology as simple appendicitis(n=92),suppurative appendicitis(n=184)and gangrenous appendicitis(n=86).They underwent laparoscopic-assisted appendectomy(LA)and open appendectomy(OA)under emergency.Postoperative complications of laparoscopic-assisted appendectomy were evaluated in children with different pathological types.Results In simple appendicitis group,intestinal obstruction(n=2,4.3% vs. n=9,19.6%)(P=0.04)and incision infection(n=1,2.2% vs. n=8,17.4%)(P=0.024); in suppurative appendicitis group:intestinal obstruction(n=5,6.0% vs. n=14,14%)(P=0.074)and incision infection(n=5,6.0% vs. n=12,12%)(P=0.158); in gangrene appendicitis group:intestinal obstruction(n=3,6% vs. n=4,8.7%)(P=0.649); incision infection(n=5,10% vs. n=12,12%)(P=0.119).Conclusion As compared with OA,the efficacy of LA appendectomy is better for simple appendectomy.Significant differences exist in the incidence of intestinal obstruction and wound infection between LA and OA(P<0.05).Laparoscopy is not superior to simple appendicitis.No significant difference exists in the incidence of intestinal obstruction or incision infection between LA and OA in suppurative or gangrenous appendicitis(P>0.05).For non-simple appendicitis,laparoscopic appendectomy offers no advantage.Pediatric appendicitis should be diagnosed and resected laparoscopically as early as possible.
参考文献/References:
1 陈勇,王胜义.126例小儿腹腔镜下阑尾切除手术体会[J].赣南医学院学报,2011, 31(3):359-360.DOI:10.3969/j.issn.1001-5779.2011.03.016. Chen Y,Wang SY.The clinical experience of 126 cases of laparoscopic appendectomy in children[J].Journal of Gannan Medical University, 2011, 31(3):359-360.DOI:10.3969/j.issn.1001-5779.2011.03.016.
2 Semm K.Endoscopic appendectomy[J].Endoscopy,1983,15(2):59-64.DOI:10.1055/s-2007-1021466.
3 田鹏,王旺河,张超,等.腹腔镜及开腹手术治疗小儿复杂性阑尾炎268例[J].世界华人消化杂志,2010,18(8):848-850.DOI:10.3969/j.issn.10093079.2010.08.019. Tian P,Wang WH,Zhang C,et al.Laparoscopic and open appendectomy in the treatment of complicated appendicitis:a report of 268 cases[J].World Chinese Journal of Digestology,2010,18(8):848-850.DOI:10.3969/j.issn.10093079.2010.08.019.
4 Yang JC,Rivard DC,Morello FP,et al.Presumed appendiceal abscess discovered to be ruptured Meckel diverticulum following percutaneous drainage[J].Pediatr Radiol,2008,38(8):909-911.DOI:10.1007/s00247-008-0874-1.
5 陈颢,海峰,张志平,等.慢性阑尾炎腹腔镜与开腹手术切除阑尾对机体免疫功能影响的比较[J].临床医药文献电子杂志,2017,4(37):7178.DOI:10.16281/j.cnki.jocml.2017.37.031. Chen H,Hai F,Zhang ZP,et al.Comparing the effects of laparoscopic versus open appendectomy upon body immune functions in chronic appendicitis[J].Electronic Journal of Clinical Medical Literature, 2017, 4(37):7178.DOI:10.16281/j.cnki.jocml.2017.37.031.
6 王军,曹斌校,李绍刚,等.腹腔镜对急性阑尾炎腹内感染患儿炎症因子水平和免疫功能的临床影响研究[J].中华医院感染学杂志,2016,26(22):5213-5215.DOI:10.11816/cn.ni.2016-161811. Wang J,Cao BX,Li SG,et al.Clinical effects of laparoscopy upon inflammatory agent levels and immune functions in children with intraabdominal infections due to acute appendicitis[J].Chinese Journal of Nosocomiology,2016,26(22):5213-5215.DOI:10.11816/cn.ni.2016-161811.
7 王宇鹏,吴晔明.腹腔镜治疗儿童阑尾炎的系统评价[J].中华小儿外科杂志,2008,29(5):317-320.DOI:10.3760/cma.j.issn.0253-3006.2008.05.017. Wang YP,Wu YM.Systemic evaluations of laparoscopic treatment of pediatric appendicitis[J].Chinese Journal of Pediatric Surgery,2008,29(5):317-320.DOI:10.3760/cma.j.issn.0253-3006.2008.05.017.
8 郑羽,曾长青,池良杰,等.腹腔镜与开腹手术治疗高危的复杂性阑尾炎患者的对比研究[J].中华生物医学工程杂志,2016,4(31):407-410.DOI:10.3760/cma.j.issn.1674-1927.2016.05.012. Zheng Y,Zeng CQ,Chi LJ,et al.Comparing laparoscopic and open appendectomy for high-risk complicated appendicitis[J].Chinese Journal of Biomedical Engineering,2016,4(31):407-410.DOI:10.3760/cma.j.issn.1674-1927.2016.05.012.
9 张大明.复杂性阑尾炎行腹腔镜与开腹手术疗效比较及感染预防[J].中华医院感染学杂志,2013,23(14):3411-3412. Zhang DM.Comparison of clinical efficacy between laparoscopic surgery and laparotomy for complicated appendicitis and prevention of infections[J].Journal of Nosocomiology,2013,23(14):3411-3412.
10 Nadler EP,Reblock KK,et al.Laparoscopic appendectomy in children with perforated appendicitis[J].J Laparoendosc Adv Surg Tech A,2006,16(2):159-163.DOI:10.1089/lap.2006.16.159.
11 李春生,刘铜军,申震,等.腹腔镜阑尾切除术与开腹阑尾切除术的临床对比研究[J].中华普通外科杂志,2015,30(8):647-649.DOI:10.3760/cma.j.issn.1007-631X.2015.08.018. Li CS,Liu TJ,Shen Z,et al.Clinical comparison of laparoscopic versus open appendectomy[J].Chinese Journal of General Surgery,2015,30(8):647-649.DOI:10.3760/cma.j.issn.1007-631X.2015.08.018.
12 Mallick MS,Al-Qaht ani A,Al-Bass A.Laparoscopic appendectomy is a favorable alternative for complicated appendicitis in children[J].Pediatr Surg Int,2007,23(3):257-259.DOI:10.1007/s00383-006-1833-2.
13 Taqi E,Al Hadher S,Ryckman J,et al.Outcome of laparoscopic appendectomy for perforated appendicitis in children[J].J Pediatr Surg,2008,43(5):893-895.DOI:10.1016/j.jpedsurg.2007.12.033.
14 Lin HF,Wu JM,Tseng LM,et al.Laparoscopic versus open appendectomy for perforated appendicitis[J].J Gastrointest Surg,2006,10(6):906-910.DOI:10.1016/j.gassur.2005.12.012.
15 尤小兰,王元杰,连彦军,等.腹腔镜下阑尾残端荷包缝合与单纯结扎的临床疗效评价[J].中华胃肠外科杂志,2015,18(12):1272-1273.DOI:10.3760/cma.j.issn.1671-0274.2015.12.024. You XL,Wang YJ,Lian YJ,et al.Clinical efficacy evaluations of laparoscopic purse-string suturing of appendiceal stump versus simple ligation[J].Chinese Journal of Gastrointestinal Surgery,2015,18(12):1272-1273.DOI:10.3760/cma.j.issn.1671-0274.2015.12.024.
16 Aranda-Narvaez JM,Gonzalez-Sanchez AJ,Marin-Camero N,et al.Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon[J].Rev Esp Enferm Dig,2010,102(11):648-652.DOI:10.4321/S1130-01082010000100005.
17 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.Efficacy comparison of laparoscopic versus open appendectomy for perforated appendicitis in children[J].Journal of Clinical Pediatric Surgery,2018,17(3):223-225.DOI:10.3969/j.issn.1671-6353.2018.03.013.
18 杨龙江,宗大伟, 郭宏讯,等. 8字形缝合法腹腔镜阑尾切除术68例[J].中国基层医药,2003,10(7):627-628.DOI:10.3760/cma.j.issn.1008-6706.2003.07.025. Yang LJ,Zong DW,Guo HX,et al.68 cases of laparoscopic appendectomy with 8-shaped suture[J].Chinese Journal of Primary Medicine,2003,10(7):627-628.DOI:10.3760/cma.j. Issn.1008-6706.2003.07.025.
19 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.DOI:10.1007/s00464-005-0249-8.
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备注/Memo
收稿日期:2018-10-25。
基金项目:江苏省青年医学重点人才，江苏省卫生计生委项目（编号：QNRC2016373）
通讯作者:禚保彪,Email:zhuobaobiao@163.com