Laparoscopic versus open appendicectomy: prospective randomised trial
Laparoscopic versus open appendicectomy: prospective randomised trial
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腹腔镜与开腹阑尾切除术：前瞻性随机试验
DOI：
10.1016/0140-6736(93)91757-d
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
A. Li
中科院分区：
文献类型：
--
作者：
J. Tate;J. Dawson;S. Chung;W. Lau;A. Li
随机评估新的腹腔镜手术技术是困难的。外科医生需要时间来熟悉这些方法，当他们有经验时，倾向于选择一种或另一种方法。我们进行了一项前瞻性随机比较腹腔镜和传统的阑尾切除术，由经验相当的外科医生对疑似急性阑尾炎患者进行。术后管理决策由外科医生而非手术医生做出。140例患者被随机分配接受开放式（OA）或腹腔镜（LA）阑尾切除术（各70例）。两组患者的年龄、性别比例、症状持续时间和组织学证实的阑尾炎患者比例相似。LA的手术时间长于OA（平均70.3 [SD 21.9] vs46.5 [25.9] min; p<0.001）。两组均无重大术中并发症。LA组中有14例（20%）患者需要转为开放手术。两组术后疼痛评分、镇痛剂需求、恢复饮食时间或住院时间无显著差异。46例LA患者和42例OA患者在术后3周接受随访。类似比例的人重返工作岗位（36人[79%] vs 31人[74%]）。伤口并发症和出院后伤口疼痛的发生率在LA后较低，但不显著。我们得出结论，LA和传统OA术后病程无显著差异。
Randomised assessment of new laparoscopic surgical techniques is difficult. Surgeons need time to become experienced with the methods and tend, when they have experience, to favour one or other approach. We have carried out a prospective randomised comparison of laparoscopic and conventional appendicectomy done by surgeons of comparable experience in patients with suspected acute appendicitis. Postoperative management decisions were made by surgeons other than the operating surgeon. 140 patients were randomly assigned to open (OA) or laparoscopic (LA) appendicectomy (70 each). The age, sex ratio, duration of symptoms, and proportion of patients with histologically confirmed appendicitis was similar in the two groups. Operating time was longer for LA than for OA (mean 70·3 [SD 21·9]vs46·5 [25·9] min; p<0·001). There were no major intraoperative complications in either group. 14 (20%) patients in the LA group required conversion to an open operation. No significant differences between the groups were found postoperatively for pain score, analgesic requirement, time to reintroduction of diet, or hospital stay. 46 LA patients and 42 OA patients attended follow-up 3 weeks after surgery. Similar proportions had returned to work (36 [79%] vs 31 [74%]). The frequency of wound complications and wound pain after leaving hospital was lower after LA but not significantly so. We conclude that the postoperative course after LA and conventional OA does not differ significantly.