CAJ | 학술논문

目的探讨腹腔镜阑尾切除手术(laparoscopic appendectomy,LA)后常见并发症切口感染的发生情况.方法回顾性分析2011-2013年华东地区6家县市级医院所有急性阑尾炎手术患者的临床资料,对LA和开腹阑尾切除术(open appendectomy,OA)后的结果进行对比,并对所有阑尾切除术后导致切口感染的危险因素进行多因素回归分析.结果 9 340例患者中行LA阑尾切除术1 831例(19.6％),开腹阑尾切除术7 509例(80.4％);3年间LA手术开展的比例分别为9.2％、15.0％及32.9％.所有阑尾切除患者的术后切口感染并发症发生率为5.1％,其中LA为2.1％,OA为5.8％,两者差异有统计学意义(x2 =41.22,P＜0.01);3年间LA术后切口感染并发症发生率分别为5.6％、4.4％及3.5％,呈逐年下降趋势(x2=31.59,P＜0.01).多因素回归分析证实,不同手术方式是导致阑尾切除术后并发切口感染的一项独立影响因素(优势比1.37,95％可信区间1.12 ～1.63,P =0.02).结论 LA阑尾切除术后切口感染的发生率逐年下降,LA手术是阑尾切除术后并发切口感染的独立保护因素.
목적 탐토복강경란미절제수술(laparoscopic appendectomy,LA)후상견병발증절구감염적발생정황.방법 회고성분석2011-2013년화동지구6가현시급의원소유급성란미염수술환자적림상자료,대LA화개복란미절제술(open appendectomy,OA)후적결과진행대비,병대소유란미절제술후도치절구감염적위험인소진행다인소회귀분석.결과 9 340례환자중행LA란미절제술1 831례(19.6％),개복란미절제술7 509례(80.4％);3년간LA수술개전적비례분별위9.2％、15.0％급32.9％.소유란미절제환자적술후절구감염병발증발생솔위5.1％,기중LA위2.1％,OA위5.8％,량자차이유통계학의의(x2 =41.22,P＜0.01);3년간LA술후절구감염병발증발생솔분별위5.6％、4.4％급3.5％,정축년하강추세(x2=31.59,P＜0.01).다인소회귀분석증실,불동수술방식시도치란미절제술후병발절구감염적일항독립영향인소(우세비1.37,95％가신구간1.12 ～1.63,P =0.02).결론 LA란미절제술후절구감염적발생솔축년하강,LA수술시란미절제술후병발절구감염적독립보호인소.
Objective Emergency laparoscopic appendectomy (LA) has been rapidly applied at county-level hospitals in China.This study is to analyze wound infection after appendectomy.Methods This retrospective study was conducted among patients with acute appendicitis undergoing either laparoscopic or open appendectomy (OA) at 6 county-level general hospitals in Eastern China from 2011 to 2013,using multivariate Logistic regression model to assess independent risk factors associated with wound infection.Results Among 9 340 patients,1 831 (19.6％) and 7 509 (80.4％) patients underwent LA and OA respectively.The overall postoperative wound infection rate was 5.1％.The proportion of LAs increased yearly from 9.2％ to 15.0％ to 32.9％,while the LA postoperative wound infection rate decreased from 5.6％ to 4.4％ to 3.5％ (P ＜ 0.05).Compared with OA,LA was associated with lower wound infection rate after appendectomy (2.1％ vs.5.8％,P ＜ 0.01).By multivariate logistic regression analysis,various procedure was found to be independently associated with postoperative wound infection [odds ratio (95％ confidence interval) OR (95％ CI),1.37 (1.12-1.63); P =0.02].Conclusions Laparoscopic appendectomy carries a decreasing postoperative wound infection rate by year basis.Laparoscopic procedure was independently associated with a significantly lower incidence of wound infection after appendectomy.