XU Maiyu,MA Zhongwu,CHEN Feng, et al. Clinical application of non-pneumoperitoneum laparoscopic appendectomy in super senior patients[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2019, 49(11): 853-856.
摘要目的：探讨悬吊式无气腹腹腔镜阑尾切除术（NLA）在超高龄急性阑尾炎患者中的应用价值。方法：回顾性分析2011年6月至2018年6月温州市中心医院急诊收治的55例超高龄（年龄≥80岁）急性阑尾炎患者的临床资料，其中27例急诊行NLA（NLA组），28例急诊行开腹阑尾切除术（OA组），比较2组手术时间、术中出血量、术后6～24 h疼痛程度、术后肠道功能恢复时间、术后住院时间、并发症发生率及住院费用。结果：NLA组在术后6～24 h疼痛程度、术后肠道功能恢复时间及术后住院时间上对比OA组，优势明显，差异有统计学意义（P＜0.05）。2组在手术时间及术中出血量上差异无统计学意义。NLA组1例出现切口感染（为1.0 cm
观察trocar），OA组有4例切口感染，差异无统计学意义；NLA组和OA组分别有4例和5例患者出现术后肺部感染，均经抗炎及雾化治疗后恢复，差异无统计学意义。OA组在整体住院费用上比NLA组少，差异有统计学意义（P＜0.05）。结论：NLA应用于超高龄急性阑尾炎患者安全可靠，且术后恢复具有一定优势。
Abstract：Objective: To evaluate the value of non-pneumoperitoneum laparoscopic appendectomy (NLA) in super senior patients with acute appendicitis. Methods: The overall clinical data of 55 cases of appendicectomy (age≥80 years), which were consisted of 27 cases of NLA and 28 cases of open appendectomy (OA), were collected retrospectively. The operative time, intraoperative blood loss, postoperative pain level (6~24 h), postoperative intestinal function recovery time, postoperative hospital stay, complications and hospitalization cost were compared between the two groups. Results: Compared with the OA group, The NLA group had a obvious advantage in postoperative pain level (6~24 h), postoperative intestinal function recovery time and postoperative hospital stay, the difference was statistically significant (P<0.05). There was no significant difference in the operation time and intraoperative blood loss between the two groups. There was 1 case of incision infection in the NLA group (trocar for 1.0 cm), and 4 cases of incision infection in the OA group. The difference was not statistically significant. There were 4 cases and 5 cases in the NLA group and OA group. Postoperative pulmonary infection occurred in 4 patients and 5 patients in NLA group and OA group, respectively, and recovered after anti-inflammatory and aerosol therapy. The difference was not statistically significant. The overall hospitalization cost of the OA group was lower than that of the NLA group, and the difference was statistically significant (P<0.05). Conclusion: NLA is as safe and feasible for super senior patients with acute appendicitis. The units with mature laparoscopic techniques deserve to be popularized.
[1] 帕帕斯, 莱尔, 哈尼施. 腹腔镜外科手术图谱[M]. 耿智敏, 译. 3版. 北京: 世界图书出版公司, 2012: 101-111.
[2] PASCUAL M, SALVANS S, PERA M. Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations[J]. World J Gastroenterol, 2016, 22(2): 704-717.
[3] 麻忠武, 陈峰, 徐迈宇, 等. 经脐单孔与三孔法腹腔镜胆囊、
阑尾联合切除的对比研究[J]. 中国微创外科杂志, 2014, 14(10): 1169-1170.
[4] 陈孝平, 汪建平. 外科学[M]. 8版. 北京: 人民卫生出版社, 2013: 391-392.
[5] CIFTCI F. Laparoscopic vs mini-incision open appendecto-my[J]. World J Gastrointest Surg, 2015, 7(10): 267-272.
[6] 刘兴军, 吴硕东, 陈永生. 经脐单切口与传统三孔腹腔镜阑尾切除术的回顾性对比研究[J]. 中国微创外科杂志, 2016, 16(9): 784-786.
[7] 张弦, 徐继宗, 付广, 等. 腹腔镜阑尾切除术与开腹手术的对比研究[J]. 中国微创外科杂志, 2015, 15(9): 798-800.
[8] TAKADA J, ARAKI H, ONOGI F, et al. Safety and efficacy of carbon dioxide insufflation during gastric endoscopic submucosal dissection[J]. World J Gastroenterol, 2015, 21(26): 8195-8202.
[9] MEFTAHUZZAMAN S M, ISLAM M M, CHOWDHURY K K, et al. Haemodynamic and end tidal CO2 changes during laparoscopic cholecystectomyunder general anaesthesia[J]. Mymensingh Med J, 2013, 22(3): 473-477.
[10] 王金保, 王姝媛, 王琪, 等. 不同气腹压条件下腹腔镜胆囊摘除术患者血流动力学的变化[J]. 临床麻醉学杂志, 2012, 28(2): 163-165.
[11] VLOT J, WIJNEN R, STOLKER R J, et al. Optimizing working space in porcine laparoscopy: CT measurement of the effects of intra-abdominal pressure[J]. Surg Endosc, 2013, 27(5): 1668-1673.
[12] LEE S I, NA B G, YOO Y S, et al. Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients[J]. Ann Surg Treat Res, 2015, 88(3): 145-151.
