【摘要】：目的:探討開腹手術及腹腔鏡手術治療復雜性闌尾炎的優(yōu)缺點,為臨床合理選擇手術方式提供依據(jù)。方法:本課題回顧性收集分析皖南醫(yī)學院第一附屬醫(yī)院2012-2014年復雜性闌尾炎病例,共有160例患者術后診斷為復雜性闌尾炎,符合納入診斷標準,此中腹腔鏡闌尾切除術(Laparoscopic appendectomy,LA)組含有65例,傳統(tǒng)開腹闌尾切除術(open appendectomy,OA)組95例,其中有4例初為腹腔鏡探查后無法順利完成手術,后中轉(zhuǎn)開腹手術。通過比較對比分析,患者年齡,性別,發(fā)病時間至手術時間、血白細胞計數(shù)、中性粒細胞比例、病理分型、腹腔膿液量、腹腔沖洗率、腹腔引流率、手術時間、術中出血、切口長度、肛門排氣時間、下床活動時間、住院費用、住院時間、以及術后并發(fā)癥(切口感染或穿刺孔感染、肺部感染、腹腔膿腫、腸梗阻、腸瘺、出血等)的發(fā)生率。結果:LA組及OA組的年齡、性別、術前WBC、N計數(shù)、病理分型、腹腔膿液量、腹腔引流率、手術時間、肺部感染發(fā)生率、腸梗阻發(fā)生率、腹腔膿腫發(fā)生率、住院費用等差異均無統(tǒng)計學差異(P0.05)。LA組及OA組腹腔沖洗率分別為100%、23.1%,LA組腹腔沖洗率明顯高于OA組,兩組差異有統(tǒng)計學意義(P0.05)。術中出血分別為31.2±21.4ml、45.2±38.1ml,OA組術中出血量高于LA組,差異有統(tǒng)計學意義(P0.05)。手術切口長度分別為2.2±0.5cm、6.3±2.4cm,OA組手術切口長度長于LA組,差異有統(tǒng)計學意義(P0.05)。LA組及OA組下床活動時間分別為2.29±0.98d、2.91±0.75d,LA組術后下床活動時間較OA組早,差異有統(tǒng)計學意義(P0.05)。肛門通氣時間分別為2.22±1.07d、2.75±0.84d,LA組術后肛門排氣時間較OA組早,差異有統(tǒng)計學意義(P0.05)。住院時間分別為7.26±3.16d、8.55±4.85d,LA組術后住院時間短語OA組,差異有統(tǒng)計學意義(P0.05)。術后總并發(fā)癥發(fā)生率分別為4.9%、16.8%,OA組術后并發(fā)癥發(fā)生率高于LA組,差異有統(tǒng)計學意義(P0.05)。并發(fā)癥切口感染(穿刺孔感染)分別為1.6%、10.5%,LA組術后切口感染率低于OA組,差異有統(tǒng)計學意義(P0.05)。結論:LA與OA相比,具有創(chuàng)傷小、恢復快、術后并發(fā)癥少、住院時間短等優(yōu)點,在治療復雜性闌尾炎方面,LA可能是一種有效的、安全的手術方式。
[Abstract]:Objective: to explore the advantages and disadvantages of laparotomy and laparoscopic surgery in the treatment of complicated appendicitis, and to provide the basis for the rational selection of surgical methods. Methods: the patients with complicated appendicitis in the first affiliated Hospital of Southern Anhui Medical College from 2012 to 2014 were retrospectively collected and analyzed. A total of 160 patients were diagnosed as complicated appendicitis after operation, which met the criteria of inclusion diagnosis. There were 65 cases in laparoscopic appendectomy (Laparoscopic appendectomy,LA) group and 95 cases in traditional open appendectomy (open appendectomy,OA) group. Age, sex, onset time to operation time, leukocyte count, neutrophil ratio, pathological classification, peritoneal empyema, celiac irrigation rate, celiac drainage rate, operative time, intraoperative bleeding were compared and analyzed. Length of incision, time of anal exhaust, time of getting out of bed, cost of hospitalization, hospital stay, and incidence of postoperative complications (incision infection or puncture hole infection, pulmonary infection, abdominal abscess, intestinal obstruction, intestinal fistula, bleeding, etc.). Results the age, sex, preoperative WBC,N count, pathological classification, celiac empyema, celiac drainage rate, operative time, pulmonary infection rate, intestinal obstruction rate, abdominal abscess rate, the age, sex, preoperative WBC,N count, pathological type, intraperitoneal drainage rate, lung infection rate, intestinal obstruction rate, abdominal abscess rate of the two groups were analyzed. There was no significant difference in hospitalization expenses between LA group and OA group (P 0.05). The celiac lavage rate of LA group was significantly higher than that of OA group (P 0.05). Intraoperative bleeding was 31.2 鹵21.4 ml / ml and 45.2 鹵38.1 ml / ml respectively in OA group, which was significantly higher than that in LA group (P0.05). The operative incision length in OA group was 2.2 鹵0.5 cm ~ (-1) 鹵2.4 cm ~ (-1) respectively, which was longer than that in LA group (P0.05). The time of getting out of bed in LA group and OA group was 2.29 鹵0.98 days and 2.91 鹵0.75 days after operation, respectively, which was significantly earlier than that in OA group (P0.05). The anal ventilation time of LA group was 2.22 鹵1.07d and 2.75 鹵0.84d respectively, which was earlier than that of OA group (P0.05). The hospitalization time of LA group was 7.26 鹵3.16 days and 8.55 鹵4.85 days after operation respectively, the difference was statistically significant (P0.05). The incidence of postoperative complications in the OA group was higher than that in the LA group (P 0.05). The postoperative infection rate of incision infection (puncture hole infection) in the complications group (1.6%) was significantly lower than that in the OA group (P0.05). Conclusion compared with OA, Ve-LA has the advantages of less trauma, faster recovery, less postoperative complications and shorter hospital stay. It may be an effective and safe surgical method in the treatment of complicated appendicitis.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R656.8

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