CAJ | 학술논문

目的：探讨小儿阑尾炎穿孔采用腹腔镜手术治疗的临床效果及安全性。方法回顾2011年9月至2013年12月收治的137例阑尾炎穿孔患儿的临床资料。根据手术方式分为腹腔镜组（腹腔镜手术）73例和传统组（传统开腹手术）64例。比较两组患儿手术指标，入院时、术后24 h、术后48 h 的血清降钙素原（ PCT）、C 反应蛋白（ CRP）水平和手术并发症的发生情况。结果两组患儿的手术均全部成功，腹腔镜组无患儿中转开腹；腹腔镜组的手术时间、术中出血量、术后排气时间、下床活动时间、住院时间均显著的低于传统组患儿（ P ﹤0.05）。腹腔镜组和传统组在入院时的PCT、CRP 检查值比较差异均无统计学意义（ P ﹥0.05）；两组患儿术后24 h 时PCT、CRP 检测值较术前均有不同程度的升高（ P ﹤0.05）、术后第48 h 均显著的回落（ P ﹤0.05）；术后24 h、48 h 腹腔镜组患儿的PCT、CRP 检查值低于传统组（ P ﹤0.05）。腹腔镜组患儿的并发症发生率和术后镇痛药使用率均显著低于传统组，差异具有统计学意义（ P ﹤0.05）。结论采用腹腔镜手术治疗小儿阑尾炎穿孔较传统开腹手术具有创伤小、恢复快、术后并发症发生率低的优点。
목적：탐토소인란미염천공채용복강경수술치료적림상효과급안전성。방법회고2011년9월지2013년12월수치적137례란미염천공환인적림상자료。근거수술방식분위복강경조（복강경수술）73례화전통조（전통개복수술）64례。비교량조환인수술지표，입원시、술후24 h、술후48 h 적혈청강개소원（ PCT）、C 반응단백（ CRP）수평화수술병발증적발생정황。결과량조환인적수술균전부성공，복강경조무환인중전개복；복강경조적수술시간、술중출혈량、술후배기시간、하상활동시간、주원시간균현저적저우전통조환인（ P ﹤0.05）。복강경조화전통조재입원시적PCT、CRP 검사치비교차이균무통계학의의（ P ﹥0.05）；량조환인술후24 h 시PCT、CRP 검측치교술전균유불동정도적승고（ P ﹤0.05）、술후제48 h 균현저적회락（ P ﹤0.05）；술후24 h、48 h 복강경조환인적PCT、CRP 검사치저우전통조（ P ﹤0.05）。복강경조환인적병발증발생솔화술후진통약사용솔균현저저우전통조，차이구유통계학의의（ P ﹤0.05）。결론채용복강경수술치료소인란미염천공교전통개복수술구유창상소、회복쾌、술후병발증발생솔저적우점。
Objective To explore the clinical effect and safety of pediatric appendicitis perforation by laparoscopic operation. Methods The clinical data of 137 cases of children with perforated appendicitis from September 2011 to December 2013 were analyzed retrospectively. They were divided into laparoscopy group(73 cases of laparoscopic operation)and the traditional group(traditional open operation)in 64 cases accord-ing to the operation mode. The surgery indicators,admission,the levels of serum procalcitonin(PCT),C - reactive protein(CRP)admission,24 h,48 h after operation and surgical complications were compared between two groups. Results Two groups were all successful operation. Laparo-scopic group had no children laparotomy. The operation time,the blood loss,postoperative exhaust time,time to ambulation,the time of hospitali-zation in laparoscopic group were significantly lower than that of the traditional group( P ﹤ 0. 05). PCT,CRP check values on admission of lapa-roscopic group and traditional group were not statistically significant( P ﹥ 0. 05). 24 h PCT,CRP detection value in pre - operation increased in different degree after operation in children with two groups( P ﹤ 0. 05). The 48 h fell significantly after operation( P ﹤ 0. 05,48 h). 24 laparo-scopic groups of children with PCT,CRP check values after operation was lower than that of the traditional group( P ﹤ 0. 05)The rate of compli-cations and postoperative analgesic usage in laparoscopic group was significantly lower than that of the traditional groups,the difference was statisti-cally significant( P ﹤ 0. 05). Conclusion Use of laparoscopic operation in the treatment of pediatric appendicitis perforation have small trauma, quick recovery,postoperative complications compared with traditional open operation.