Laparoscopic appendectomy for simple and perforated appendicitis in children: The procedure of choice?
Laparoscopic appendectomy for simple and perforated appendicitis in children: The procedure of choice?
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DOI：
10.1053/jpsu.2000.18319
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发表时间：
2000-11-01
影响因子：
2.4
通讯作者：
Brown, C
中科院分区：
文献类型：
--
作者：
Canty, TG;Collins, D;Brown, C
背景/目的：腹腔镜阑尾切除术（LA）治疗小儿单纯性（SA）和穿孔性阑尾炎（PA）是否上级开腹阑尾切除术（OA）仍存在争议。为了回答这个问题，我们对同一机构的4名资深儿科外科医生在所有病例从OA过渡到LA的6年期间的手术经验进行了研究。回顾了1993年12月至1999年12月期间所有阑尾切除术的手术技术（OA、LA）、穿孔（SA、PA）、手术时间（OT）、住院时间（LOS），结果：14个月~ 19岁儿童共行阑尾切除术1,128例，其中LA 955例（SA 653例，PA 302例），OA 173例（SA 86例，PA 87例）。在SA中，LA和OA的OT相等（52分钟），但在过去一年中，LA的OT已降至不到40分钟。PA中的OT在LA中比OA中稍长（68 v. 58分钟; P <0.001），但最近LA中的OT已降至60分钟以下。SA中LA的LOS为2天，OA为3天; PA中，LA和OA的LOS均为7天，但最近LA的LOS已降至5天。两组中LA和OA的术后脓肿率和肠梗阻发生率没有差异。结论：LA治疗单纯性阑尾炎和穿孔性阑尾炎的安全性和有效性至少与OA相同，即使不上级。术后疼痛更少，恢复更快，从而降低了LOS和总成本。可以满足对该手术日益增长的需求，而不会增加成本、发病率或死亡率。腹腔镜阑尾切除术是我们在儿童中的首选手术。Copyright（C）2000 by W.B.桑德斯公司
Background/Purpose: Whether laparoscopic appendectomy (LA) is superior to open appendectomy (OA) for simple (SA) and perforated appendicitis (PA) in children is debatable. The operative experience of 4 senior pediatric surgeons at a single institution was studied over a 6-year period during a transition from OA in all cases to LA in all cases, to answer this question.Methods: All appendectomies from December 1993 to December 1999 were reviewed for operative technique (OA, LA), presence of perforation (SA, PA), operating time (OT), length of stay (LOS), morbidity, and mortality.Results: There were 1,128 appendectomies in children aged 14 months to 19 years, including 955 LA (653 in SA, 302 in PA) and 173 OA (86 in SA, 87 in PA). OT was equal for LA and OA in SA (52 minutes), but has dropped to less than 40 minutes for LA in the past year. OT in PA was slightly longer in LA versus OA (68 v. 58 minutes; P < .001) but recently has dropped in LA to less than 60 minutes. LOS in SA was 2 days for LA and 3 days for OA; in PA, LOS was 7 days in both LA and OA, but has dropped to 5 days for LA recently. Postoperative abscess rates and incidence of bowel obstruction did not differ between LA and OA in either group. There was no mortality.Conclusions: LA is at least as safe and effective as, if not superior to, OA for both simple and perforated appendicitis. Postoperative pain is less, and recovery is faster, thereby reducing LOS and overall cost. The growing demand for this procedure can be satisfied without increase in cost, morbidity, or mortality. Laparoscopic appendectomy is our procedure of choice in children. Copyright (C) 2000 by W.B. Saunders Company.