摘要：
目的:探讨腹腔镜阑尾切除术治疗急性阑尾炎的临床效果及可行性.方法:采用计算机随机数字分组方式将符合研究纳入标准的269例急性阑尾炎患者分为两组, 分别接受常规开腹式阑尾切除术和三孔腹腔镜阑尾切除术进行治疗.对比两组手术时间、术中出血量、术后肛门排气时间、抗菌药物使用时间、住院时间、疼痛评分、术后并发症发生情况.结果:与开腹组比, 腹腔组急性单纯性阑尾炎、化脓性阑尾炎患者手术时间明显缩短, 而急性坏疽/穿孔性阑尾炎及阑尾周围脓肿患者明显加长 (P<0.05), 急性单纯性阑尾炎、急性化脓性阑尾炎、急性坏疽/穿孔性阑尾炎及阑尾周围脓肿患者术中出血量明显减少 (P<0.05) ;术后肛门排气时间、抗菌药物使用时间、住院时间均明显缩短 (P<0.05) .术后, 两组急性阑尾炎患者VAS评分均明显下降, 且与开腹组比, 腹腔组术后评分更优 (P<0.05) .两组急性阑尾炎术后并发症主要表现为切口感染、腹腔感染、残端漏、腹腔脓肿等, 腹腔镜组切口感染率及总并发症发生率明显低于开腹组 (P<0.05) .结论:腹腔镜阑尾切除术在治疗发病48h内的各类型急性阑尾炎中疗效确切, 优点突出, 尤其在急性单纯性阑尾炎、急性化脓性阑尾炎的治疗中, 可显著缩短手术时间、降低术中出血量、缓解疼痛, 有助于患者术后康复, 降低术后并发症发生率, 安全性高.%Objective:To explore the clinical effect and feasibility of laparoscopic appendectomy in the treatment of acute appendicitis.Methods:A total of 269 patients with hallmark appendicitis who met the study inclusion criteria were divided into two groups by computerized randomized digital grouping, and were treated with conventional open-lap appendectomy and three-hole laparoscopic appendectomy.The operation time, intraoperative blood loss, postoperative anal exhaust time, antibacterial drug use time, hospitalization time, pain score, and postoperative complications were compared between the two groups.Results:Compared with the open group, the operation time of patients with acute appendicitis and suppurative appendicitis in the abdominal cavity group was significantly shortened, while the patients with acute gangrene/perforated appendicitis and abscess around the appendix were significantly longer (P<0.05) ;the amount of intraoperative blood loss in patients with acute appendicitis, acute suppurative appendicitis, acute gangrene/perforated appendicitis and appendix abscess was significantly reduced (P<0.05) ;postoperative anal exhaust time, antibacterial use time, hospital stay time was significantly shortened (P<0.05).After operation, the VAS scores of the patients with acute appendicitis were significantly decreased, and the scores of the observation group were better than those in the open group (P<0.05).The postoperative complications of acute appendicitis in the two groups were mainly incision infection, abdominal infection, stump leakage, abdominal abscess, etc.The rate of incision infection total complication in the laparoscopic group was significantly lower than that in the open group (P<0.05).Conclusion:Laparoscopic appendectomy is effective in all types of acute appendicitis within 48 hours of treatment.It has outstanding advantages, especially in the treatment of acute appendicitis and acute suppurative appendicitis, which can significantly shorten the operation time, reduce the amount of intraoperative blood loss, and relieve pain.It can help patients recover after surgery, reduce the incidence of postoperative complications, and safety.
