發(fā)布時(shí)間：2018-07-27 13:36

【摘要】：目的評(píng)價(jià)腹腔鏡闌尾切除術(shù)(Laparoscopic appendectomy,LA)在治療急性化膿性及壞疽性闌尾炎的優(yōu)缺點(diǎn)。方法本研究采取回顧性研究,檢索2011年1月-2015年12月期間在我院普通外科行闌尾切除術(shù)的所有患者,其中行腹腔鏡闌尾切除術(shù)患者449例,行開(kāi)腹闌尾切除術(shù)(open appendectomy,OA)患者394例。將經(jīng)納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)篩選后最后納入LA組270例、OA組222例作為研究對(duì)象。搜集患者的一般臨床資料,首先比較一般資料差異無(wú)統(tǒng)計(jì)學(xué)意義,然后對(duì)兩組患者的切口長(zhǎng)度、出血量、手術(shù)時(shí)間、術(shù)后住院時(shí)間、止痛藥使用率、抗菌藥物使用時(shí)間、靜脈補(bǔ)液或靜脈營(yíng)養(yǎng)時(shí)間、術(shù)中探查情況、引流管放置率及留置時(shí)間、住院費(fèi)用(總費(fèi)用、術(shù)后費(fèi)用)、并發(fā)癥(切口感染、腸梗阻、腹腔膿腫)等發(fā)生率進(jìn)行比較。結(jié)果腹腔鏡組患者275例,5例中轉(zhuǎn)開(kāi)腹,剔除統(tǒng)計(jì);開(kāi)腹闌尾切除術(shù)患者222例;兩組患者基本資料比較差異無(wú)統(tǒng)計(jì)學(xué)意義;腹腔鏡組手術(shù)切口明顯較短(LA組2.42±0.18,OA組4.81±2.17cm);腹腔鏡組出血量明顯較少(LA組9.20±8.85ml,OA組16.37±14.91ml);腹腔鏡組引流管放置率較低,留置時(shí)間較短(LA組38例(14.1%)、1.66±1.10天,OA組68例(30.6%)、2.56±1.51天);差異均有統(tǒng)計(jì)學(xué)意義。腹腔鏡組手術(shù)時(shí)間略長(zhǎng)(LA組63.56±33.77,OA組63.24±20.52min),但差異無(wú)統(tǒng)計(jì)學(xué)意義。住院總費(fèi)用略高(在LA組10358.47±1742.12元,OA組8388.86±2111.75元),但腹腔鏡組術(shù)后花費(fèi)反而較低(LA組3494.32±1672.91元,OA組3948.04±2111.75元),差異均有統(tǒng)計(jì)學(xué)意義。腹腔鏡組恢復(fù)下地活動(dòng)早(LA組6.85±2.30小時(shí),OA組13.35±9.73小時(shí)),肛門(mén)恢復(fù)排氣時(shí)間早(LA組15.60±8.72小時(shí),OA組21.59±16.32小時(shí)),靜脈補(bǔ)液或靜脈營(yíng)養(yǎng)的時(shí)間腹腔鏡組短于開(kāi)腹組(LA組1.87±0.69天,OA組3.47±1.79天);止痛藥使用率較低(LA組19.6%,OA組48.7%),抗菌藥物使用時(shí)間短(LA組3.67±1.42天,OA組5.74±3.16天),住院時(shí)間短(LA組6.51±3.81天,OA組4.50±1.86天),并發(fā)癥發(fā)生較少(LA組5例(1.9%),OA組36例(16.2%)),差異均有統(tǒng)計(jì)學(xué)意義。結(jié)論1腹腔鏡在急性化膿性闌尾炎及壞疽性闌尾炎的治療中是安全有效的;2在急性化膿性闌尾炎及壞疽性闌尾炎的腹腔鏡手術(shù)對(duì)比開(kāi)腹手術(shù)具有恢復(fù)快、并發(fā)癥低、住院時(shí)間短、出血少、切口美容效果好等優(yōu)勢(shì);3腹腔鏡手術(shù)開(kāi)展早期手術(shù)時(shí)間明顯長(zhǎng)于開(kāi)腹手術(shù),后期手術(shù)時(shí)間明顯縮短,甚至低于開(kāi)腹組;4接受腹腔鏡闌尾切除術(shù)患者住院總費(fèi)用高于開(kāi)腹手術(shù)組,主要費(fèi)用為腔鏡新技術(shù)、高值耗材、全麻費(fèi)用,但術(shù)后恢復(fù)費(fèi)用明顯低于開(kāi)腹手術(shù)組;5腹腔鏡闌尾切除術(shù)可作為治療急性化膿性闌尾炎及壞疽性闌尾炎的理想手術(shù)方式之一,可在臨床中推廣應(yīng)用。
[Abstract]:Objective to evaluate the advantages and disadvantages of Laparoscopic appendectomy (LA) in the treatment of acute suppurative and gangrenous appendicitis. Methods A retrospective study was conducted to retrieve all the patients undergoing appendectomy in our hospital from January 2011 to December 2015, including 449 patients undergoing laparoscopic appendectomy and 394 patients undergoing open appendectomy (OA). After selection of inclusion criteria and exclusion criteria, 222 cases of OA group and 270 cases of LA group were included in the study. To collect the general clinical data of the patients, the difference in general data was not statistically significant first. Then, the incision length, bleeding volume, operation time, postoperative hospitalization time, painkiller utilization rate, time of use of antimicrobial agents were compared between the two groups. The time of venous resuscitation or venous nutrition, intraoperative exploration, drainage tube placement rate and retention time, total cost of hospitalization (total cost, postoperative cost), complications (incision infection, intestinal obstruction, celiac abscess) were compared. Results in the laparoscopic group, 275 cases were converted to open operation, and 222 cases underwent appendectomy, and there was no significant difference in basic data between the two groups. The operative incision in the laparoscopic group was significantly shorter (LA group 2.42 鹵0.18 vs OA group 4.81 鹵2.17cm), the bleeding volume in the laparoscopic group was significantly less (LA group 9.20 鹵8.85 ml / OA group 16.37 鹵14.91ml), the drainage tube placement rate in the laparoscopic group was lower, and the retention time was shorter (LA group 38 cases (14.1%) 1.66 鹵1.10 days OA group, 68 cases (30.6%) 鹵1.51 days), the difference was statistically significant. The operative time of laparoscopic group was a little longer (LA group 63.56 鹵33.7 vs OA group 63.24 鹵20.52min), but the difference was not statistically significant. The total cost of hospitalization was slightly higher (10358.47 鹵1742.12 yuan in LA group, 8388.86 鹵2111.75 yuan in OA group), but lower in laparoscopic group (3494.32 鹵1672.91 yuan in LA group, 3948.04 鹵2111.75 yuan in OA group). The recovery of subsurface activity was earlier in the laparoscopic group (6.85 鹵2.30 hours in LA group, 13.35 鹵9.73 hours in OA group), and the recovery time in anal exhaust was earlier (15.60 鹵8.72 hours in LA group, 21.59 鹵16.32 hours in OA group). The time of venous resuscitation or venous nutrition in laparoscopic group was shorter than that in open group (LA group 1.87 鹵0.69 days OA group 3.47 鹵1.79 days). The usage rate of analgesic was low (48.7% in LA group), the time of using antibiotics was short (5.74 鹵3.16 days in LA group, 5.74 鹵3.16 days in OA group), the hospitalization time was short (6.51 鹵3.81 days in LA group, 4.50 鹵1.86 days in OA group), and the complications were less (LA group 5 cases (1.9%), OA group 36 cases (16.2%),). Conclusion 1 Laparoscopy is safe and effective in the treatment of acute suppurative appendicitis and gangrenous appendicitis. The early operative time of laparoscopic surgery was significantly longer than that of open surgery, and the later operative time was shortened obviously. The total hospitalization cost of patients undergoing laparoscopic appendectomy was higher than that of laparotomy group. The main expenses were new endoscopic technology, high value consumables, general anesthesia, etc. But the cost of postoperative recovery was significantly lower than that of laparotomy group. Laparoscopic appendectomy was one of the ideal methods for the treatment of acute suppurative appendicitis and gangrenous appendicitis, and could be popularized in clinical practice.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R656.8

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉冰熔;王宏光;孫相釗;葉麗萍;田戩;馮佳;鄭東林;楊卓;曲波;殷積彬;王曼彤;葉營(yíng);魯?shù)顦s;王東旭;張靖;馮子壇;麻樹(shù)人;馬驍;;內(nèi)鏡逆行闌尾炎治療術(shù)應(yīng)用多中心回顧性分析[J];中華消化內(nèi)鏡雜志;2016年08期

2 李登位;周正;;闌尾炎手術(shù)方式的微創(chuàng)演變及其進(jìn)展[J];中日友好醫(yī)院學(xué)報(bào);2015年06期

3 呂挺正;陳功;鄭珊;;某醫(yī)院20年間陰性闌尾切除調(diào)查與分析[J];臨床小兒外科雜志;2015年03期

4 林俊青;劉春慶;;腹腔鏡闌尾切除術(shù)中轉(zhuǎn)開(kāi)腹的臨床分析[J];中國(guó)醫(yī)學(xué)創(chuàng)新;2015年13期

5 王家亮;葛步軍;黃琦;劉黎明;陳清;;免氣腹與傳統(tǒng)腹腔鏡闌尾切除術(shù)的隨機(jī)對(duì)照研究[J];中華普通外科雜志;2014年11期

6 陳偉;楊占雷;王紅鵬;姚南;;腹腔鏡診斷治療兒童闌尾炎的進(jìn)展及前景[J];黑龍江醫(yī)學(xué);2014年03期

7 張偉耀;周霞;;腹腔鏡闌尾切除術(shù)與開(kāi)腹闌尾切除術(shù)的并發(fā)癥大樣本對(duì)比分析[J];中國(guó)全科醫(yī)學(xué);2014年03期

8 郭維;;急性闌尾炎病理分型與超聲圖像特征的對(duì)比分析[J];現(xiàn)代診斷與治療;2013年20期

9 司宇光;;急性單純性闌尾炎的保守治療體會(huì)[J];中國(guó)醫(yī)療前沿;2013年08期

10 王有利;劉凡;葉穎江;申占龍;尹慕軍;姜可偉;王杉;;腹腔鏡闌尾切除術(shù)在急性和慢性闌尾炎中應(yīng)用療效的比較[J];中華普通外科雜志;2013年02期

相關(guān)博士學(xué)位論文 前1條

1 歐鵬;腹腔鏡闌尾切除術(shù)與開(kāi)腹闌尾切除術(shù)的臨床對(duì)比研究[D];中南大學(xué);2012年

相關(guān)碩士學(xué)位論文 前1條

1 李忠;腹腔鏡闌尾切除術(shù)與開(kāi)腹闌尾切除術(shù)的臨床對(duì)比研究[D];新疆醫(yī)科大學(xué);2014年

，

本文編號(hào)：2147998