| 摘要: |
| 目的:探讨化脓性阑尾炎不同时机行腹腔镜阑尾切除术的临床效果。方法:选取2016 年6 月—2018 年6 月我院收治的化脓性阑尾炎患者70 例，按照手术时机分组，以病发至手术时间<24 h 患者38 例为早期组，以病发至手术时间>72 h 患者32 例为延期组，术前均给予中医灌肠和静脉滴注抗生素治疗，观察两组手术前后白细胞计数、中性粒细胞百分比及手术时间、术中脓液引流量、中转开腹例数、胃肠功能恢复时间、术后抗生素应用时间、不良反应发生率、总住院时间、住院费用等相关手术指标，并对两组患者腹腔渗液做细菌培养，比较两组腹腔渗液致病细菌阳性率。结果:早期组术前白细胞计数与中性粒细胞百分比为(10.56±2.98)×109/L、(80.21±9.15)%，明显高于延期组(8.07±3.04)×109/L、(68.75±10.27)%，差异有统计学意义(P <0.05)；术后白细胞计数及中性粒细胞百分比早期组分别为(6.87±1.98)×109/L、(5.86±2.76)%，延期组为(6.92±2.17)×109/L、(5.63±3.01)%，差异无统计学意义(P >0.05)；早期组手术时间(60.18±14.39)min、术中出血量(6.26±4.71)mL、胃肠功能恢复时间(2.07±0.76)天，与延期组手术时间(56.84±12.79)min、术中出血量(5.14±3.49)mL、胃肠功能恢复时间(2.18±0.85)天比较，差异无统计学意义(P >0.05)；早期组术中脓液引流量(42.96±30.57)mL、术后抗生素应用时间(4.18±1.06)天，均明显高于延期组术中脓液引流量(24.83±18.69)mL、术后抗生素应用时间(3.39±1.02)天，差异有统计学意义(P <0.05)；早期组中转开腹0 例、发生肠梗阻2 例、切口感染1 例，不良情况发生率7.89%，延期组中转开腹2 例，发生肠梗阻1 例，切口感染1 例，不良情况发生率12.50%，差异无统计学意义(P >0.05)；早期组腹腔渗液致病菌阳性率28.95%(11 例)，延期组12.50%(4 例)，早期组明显高于延期组，差异有统计学意义(P <0.05)；早期组总住院时间(5.53±1.16)d、住院费用(1.07±0.25)万，低于延期组总住院时间(7.69±1.83)天、住院费用(1.28±0.31)万，差异有统计学意义(P <0.05)。结论:化脓性阑尾炎行腹腔镜早期手术及延期手术均有可靠疗效，延期手术具有术中脓液引流量少、术后抗生素应用时间短等优势，但总住院时间和住院费用较高，在确诊需手术治疗的情况下，还应提早手术，以尽快促进身体康复。 |
| 关键词: 不同时机 腹腔镜 化脓性阑尾炎 切除 |
| DOI：10.3969/j.issn.1007-6948.2020.03.023 |
| 投稿时间：2019-12-10 |
| 基金项目: |
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| Comparative Analysis of the Curative Effect of Laparoscopic Appendectomy at Different Time for Suppurative Appendicitis |
| ZHANG Hong-jian,LI Rong-lin |
| Department of the Second General Surgery,Tianjin Ninghe District Hospital, Tianjin 301500, China |
| Abstract: |
| Objective To investigate the clinical effects of laparoscopic appendectomy at different times.Methods Select 70 cases of purulent appendicitis patients admitted to our hospital from June 2016 to June 2018,which were grouped according to the timing of surgery. 38 cases of patients with disease to operation time of 24 hours as the early group, with the disease to the time of operation. 32 cases of 72 hours patients as the extension group, and 32 cases of patients with surgery at the time of the disease is 72 hours as the extension group. Before the operation, they were given Chinese medicine filling and intravenous drip antibiotic treatment. To observe two groups the following indicators before and after surgery, such as white blood cell count, the percentage of neutral cells and the time of surgery, the flow of pus in surgery, the number of transit-opening abdominal cases,gastrointestinal function recovery time, postoperative antibiotic application time, the incidence of adverse reactions, the total length of hospitalization,hospitalization costs. Abdominal cavity drainage of the two groups of patients were measured bacterial culture. The positive rate of pathogenic bacteria in two groups of celiac seepage were compared. Results The preoperative white blood cell count and neutrophil percentage in the early group were (10.56±2.98)×109/L and (80.21±9.15)%, which was signi?cantly higher than those in the delayed group(8.07±3.04)×109/L and (68.75± 10.27)%. The difference was statistically significant (P<0.05). The early group of white blood cell count and neutrophil percentage in the postoperative group were (6.87±1.98)×109/L and (5.86±2.76)%. The delayed group was (6.92±2.17)×109/L and (5.63±3.01)%, which the difference was not statistically signi?cant (P>0.05). The early operation time [(60.18±14.39) min], intraoperative blood loss [(6.26±4.71) mL], gastrointestinal function recovery time [(2.07±0.76) d] and delayed operation time [(56.84±12.79) min], intraoperative blood loss [(5.14±3.49) mL], gastrointestinal function recovery time [(2.18±0.85) d] were compared, which the difference was not statistically significant (P>0.05). The pus drainage volume [(42.96±30.57) mL] and the postoperative antibiotic application time [(4.18±1.06) d] in the early group were signi?cantly higher than those in the delayed group. The drainage volume [(24.83±18.69) mL] and the postoperative antibiotic application time [(3.39±1.02) d] were measured, which the difference was statistically signi?cant (P<0.05). In the period group, 0 case was converted to open surgery, 2 cases had intestinal obstruction, 1 case had wound infection, the incidence of adverse events was 7.89%, 2 cases were converted to open surgery in the extended group, 1 case had intestinal obstruction, 1 case had wound infection, and the incidence of adverse events was 12.50%. The difference was not statistically significant (P>0.05). The positive rate of pathogenic bacteria in the early group was 28.95% (11 cases), and the delayed group was 12.50% (4 cases). Compared with the two groups, the early group was signi?cantly higher than the delayed group. The difference was statistically significant (P<0.05). The total group hospitalization time [(5.53±1.16) d], hospitalization expenses [(1.07±0.25) million], and the total hospitalization time [(7.69±1.83) d], hospitalization expenses [(1.28±0.31) million] were signi?cantly lower, which the difference was statistically signi?cant (P<0.05). Conclusion The early operation of laparoscopic and the delayed surgery of purulent appendicitis have reliable results. Delayed surgery has the advantages of less intraoperative pus drainage. It can shorten the antibiotic application time, but the total hospitalization time and hospitalization cost are higher. In the case of surgery, early surgery should be performed to promote physical recovery as soon as possible. |
| Key words: Different timing laparoscopy suppurative appendicitis resection |
