• 川北醫(yī)學(xué)院附屬醫(yī)院普外科(四川南充 637000);

目的再次探討腹腔鏡闌尾切除術(shù)的手術(shù)價值。方法收集川北醫(yī)學(xué)院附屬醫(yī)院普通外科2009年4月至2010年12月期間收治的已行闌尾切除術(shù)的闌尾炎患者共200例的臨床資料，比較行腹腔鏡闌尾切除術(shù)(腹腔鏡組)和開腹闌尾切除術(shù)(開腹組)患者的手術(shù)時間、術(shù)后住院時間、住院費用、術(shù)后肛門排氣時間、術(shù)后疼痛得分、手術(shù)并發(fā)癥等。結(jié)果腹腔鏡組8例患者中轉(zhuǎn)開腹。腹腔鏡組住院費用高于開腹組(P lt;0.05); 慢性闌尾炎、急性單純性闌尾炎、發(fā)病36 h內(nèi)的急性化膿性闌尾炎在腹腔鏡組較開腹組手術(shù)時間短、術(shù)后住院時間短、肛門排氣時間較早、術(shù)后疼痛輕(P lt;0.05); 超過36 h的急性化膿性闌尾炎及急性壞疽性闌尾炎2組在術(shù)后住院時間、肛門排氣時間、術(shù)后疼痛方面差異均無統(tǒng)計學(xué)意義(P gt;0.05); 急性壞疽性闌尾炎在腹腔鏡組手術(shù)時間較開腹組長(P lt;0.05)，但腹腔鏡組切口感染率較開腹組低(P lt;0.05)。結(jié)論慢性闌尾炎、急性單純性闌尾炎、發(fā)病36 h內(nèi)的急性化膿性闌尾炎經(jīng)腹腔鏡闌尾切除術(shù)治療效果確切，優(yōu)點突出，應(yīng)用價值明確; 而對于發(fā)病超過36 h的急性化膿性闌尾炎及急性壞疽性闌尾炎腹腔鏡闌尾切除術(shù)手術(shù)操作困難，中轉(zhuǎn)率高，術(shù)后恢復(fù)較開腹手術(shù)沒有明顯優(yōu)勢，并且增加了醫(yī)療費用，應(yīng)用價值不大。

引用本文： 幸天勇,趙小波,任亦星,趙國剛,彭祥玉. 腹腔鏡闌尾切除術(shù)臨床價值再探討. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(9): 982-986. doi: 復(fù)制

1. Garg CP, Vaidya BB, Chengalath MM.Efficacy of laparoscopy in complicated appendicitis [J]. Int J Surg, 2009, 7(3): 250252.
2. Richards W, Watson D, Lynch G, et al. A review of the results of laparoscopic versus open appendectomy [J]. Surg Gynecol Obstet, 1993, 177(5): 473480.
3. Dede K, Mersich T, Zaránd A, et al. Laparoscopic or open appendectomy? [J]. Orv Hetil, 2008, 149(50): 23572361.
4. 楊映弘, 岳曉林, 藺原, 等. 隱蔽三孔法腹腔鏡闌尾切除術(shù)192例報告 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006, 13(5): 591.
5. 宗行萬之助. 疼痛的估價－用特殊的視覺模擬評分法作參考(VAS) [J]. 實用疼痛學(xué)雜志, 1994, 11(4): 255257.
6. Sweeney KJ, Keane FB. Moving from open to laparoscopic appendicectomy [J]. Br J Surg, 2003, 90(3): 257258.
7. Long KH, Bannon MP, Zietlow SP, et al. A prospective randomized comparison of laparoscopic appendectomy with open appendectomy: Clinical and economic analyses [J]. Surgery, 2001, 129(4): 390400.
8. 彭志萬, 舒柏榮, 張克難, 等. 電視腹腔鏡闌尾切除術(shù)1 148例分析 [J]. 中國內(nèi)鏡雜志, 2001, 7(1): 4849.
9. 葉業(yè)興, 黃建武, 金凱, 等. 急性闌尾炎腹腔鏡闌尾切除術(shù)的臨床價值 [J]. 當(dāng)代醫(yī)學(xué), 2008, (140): 5758.
10. 龔南雄, 李震宇, 杜玉輝, 等. 腹腔鏡闌尾切除術(shù)與傳統(tǒng)闌尾切除術(shù)臨床比較分析 [J]. 中國醫(yī)藥導(dǎo)報, 2008, 5(9): 4243.
11. 鄧和軍, 李慶東, 冉崇新, 等. 腹腔鏡闌尾切除術(shù)的臨床應(yīng)用價值 [J]. 腹腔鏡外科雜志, 2004, 9(4): 241243.
12. Pandey S, Slawik S, Cross K, et al. Laparoscopic appendicectomy: a training model for laparoscopic right hemicolectomy? [J]. Colorectal Dis, 2007, 9(6): 536539.
13. 李洪樹, 陳玉濤, 唐光華, 等. 腹腔鏡闌尾切除術(shù)應(yīng)注意的幾個問題(附132例報告) [J].　中國普外基礎(chǔ)與臨床雜志, 2008, 15（5）: 367368.
14. Sporn E, Petroski GF, Mancini GJ, et al. Laparoscopic appendectomy－is it worth the cost? Trend analysis in the US from 2000 to 2005 [J]. J Am Coll Surg, 2009, 208(2): 179185.
15. Lamparelli MJ, Hoque HM, Pogson CJ, et al. A prospective evaluation of the combined use of the modified Alvarado score with selective laparoscopy in adult females in the management of suspected appendicitis [J]. Ann R Coll Surg Engl, 2000, 82(3): 192195.
16. Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis [J]. Cochrane Database Syst Rev, 2004, (4): CD001546.
17. Leung TT, Dixon E, Gill M, et al. Bowel obstruction following appendectomy: what is the true incidence? [J]. Ann Surg, 2009, 250(1): 5153.
18. Shalak F, Almulhim SI, Ghantous S, et al. Laparoscopic appendectomy: burden or benefit? A singlecenter experience [J]. J Laparoendosc Adv Surg Tech A, 2009, 19(3): 427429.
19. 張子?xùn)|. 腹腔鏡闌尾切除術(shù)58例報道 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007, 14（1）: 52.
20. Lintula H, Kokki H, Vanamo K, et al. The costs and effects of laparoscopic appendectomy in children [J]. Arch Pediatr Adolesc Med, 2004, 158(1): 3437.
  1. 1. Garg CP, Vaidya BB, Chengalath MM.Efficacy of laparoscopy in complicated appendicitis [J]. Int J Surg, 2009, 7(3): 250252.
  2. 2. Richards W, Watson D, Lynch G, et al. A review of the results of laparoscopic versus open appendectomy [J]. Surg Gynecol Obstet, 1993, 177(5): 473480.
  3. 3. Dede K, Mersich T, Zaránd A, et al. Laparoscopic or open appendectomy? [J]. Orv Hetil, 2008, 149(50): 23572361.
  4. 4. 楊映弘, 岳曉林, 藺原, 等. 隱蔽三孔法腹腔鏡闌尾切除術(shù)192例報告 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006, 13(5): 591.
  5. 5. 宗行萬之助. 疼痛的估價－用特殊的視覺模擬評分法作參考(VAS) [J]. 實用疼痛學(xué)雜志, 1994, 11(4): 255257.
  6. 6. Sweeney KJ, Keane FB. Moving from open to laparoscopic appendicectomy [J]. Br J Surg, 2003, 90(3): 257258.
  7. 7. Long KH, Bannon MP, Zietlow SP, et al. A prospective randomized comparison of laparoscopic appendectomy with open appendectomy: Clinical and economic analyses [J]. Surgery, 2001, 129(4): 390400.
  8. 8. 彭志萬, 舒柏榮, 張克難, 等. 電視腹腔鏡闌尾切除術(shù)1 148例分析 [J]. 中國內(nèi)鏡雜志, 2001, 7(1): 4849.
  9. 9. 葉業(yè)興, 黃建武, 金凱, 等. 急性闌尾炎腹腔鏡闌尾切除術(shù)的臨床價值 [J]. 當(dāng)代醫(yī)學(xué), 2008, (140): 5758.
  10. 10. 龔南雄, 李震宇, 杜玉輝, 等. 腹腔鏡闌尾切除術(shù)與傳統(tǒng)闌尾切除術(shù)臨床比較分析 [J]. 中國醫(yī)藥導(dǎo)報, 2008, 5(9): 4243.
  11. 11. 鄧和軍, 李慶東, 冉崇新, 等. 腹腔鏡闌尾切除術(shù)的臨床應(yīng)用價值 [J]. 腹腔鏡外科雜志, 2004, 9(4): 241243.
  12. 12. Pandey S, Slawik S, Cross K, et al. Laparoscopic appendicectomy: a training model for laparoscopic right hemicolectomy? [J]. Colorectal Dis, 2007, 9(6): 536539.
  13. 13. 李洪樹, 陳玉濤, 唐光華, 等. 腹腔鏡闌尾切除術(shù)應(yīng)注意的幾個問題(附132例報告) [J].　中國普外基礎(chǔ)與臨床雜志, 2008, 15（5）: 367368.
  14. 14. Sporn E, Petroski GF, Mancini GJ, et al. Laparoscopic appendectomy－is it worth the cost? Trend analysis in the US from 2000 to 2005 [J]. J Am Coll Surg, 2009, 208(2): 179185.
  15. 15. Lamparelli MJ, Hoque HM, Pogson CJ, et al. A prospective evaluation of the combined use of the modified Alvarado score with selective laparoscopy in adult females in the management of suspected appendicitis [J]. Ann R Coll Surg Engl, 2000, 82(3): 192195.
  16. 16. Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis [J]. Cochrane Database Syst Rev, 2004, (4): CD001546.
  17. 17. Leung TT, Dixon E, Gill M, et al. Bowel obstruction following appendectomy: what is the true incidence? [J]. Ann Surg, 2009, 250(1): 5153.
  18. 18. Shalak F, Almulhim SI, Ghantous S, et al. Laparoscopic appendectomy: burden or benefit? A singlecenter experience [J]. J Laparoendosc Adv Surg Tech A, 2009, 19(3): 427429.
  19. 19. 張子?xùn)|. 腹腔鏡闌尾切除術(shù)58例報道 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007, 14（1）: 52.
  20. 20. Lintula H, Kokki H, Vanamo K, et al. The costs and effects of laparoscopic appendectomy in children [J]. Arch Pediatr Adolesc Med, 2004, 158(1): 3437.