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。
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.
作者
沈阳
禚保彪
孙庆增
Shen Yang;Zhuo Baobiao;Sun Qingzeng(Xuzhou Children's Hospital,Xuzhou Medical University,Xuzhou 221000,China)
出处
《临床小儿外科杂志》
CAS
2019年第9期784-788,共5页
Journal of Clinical Pediatric Surgery
基金
江苏省青年医学重点人才
江苏省卫生计生委项目(编号:QNRC2016373)
关键词
腹腔镜
阑尾炎
儿童
Laparoscopes
Appendicitis
Child
