CAJ | 학술논문

目的：探讨腹腔镜下阑尾切除术对围术期存在高危手术风险的复杂性阑尾炎患者的疗效。方法回顾性分析2009年至2014年行阑尾切除术的所有患者,术前ASA评分为3和4的复杂性阑尾炎患者入选,分为两组：开腹阑尾切除组( open appendectomy,OA)、腹腔镜下阑尾切除组( LA)。回顾性分析两组患者手术时间、住院时间、术后并发症发生率及炎症指标的动态变化。结果 LA组与OA组相比,手术时间轻度延长(P<0.05),但住院时间缩短(P<0.05)。术后根据Clavien Dindo标准评估并发症发生率,LA组轻微并发症相对较多,但OA组严重并发症则相对较多(P<0.01)。 OA组术后WBC值逐渐下降,而LA组降低延迟(P=0.03)；OA组CPR术后轻度升高后再降低,而LA组逐渐稳定下降(P<0.05)。结论腹腔镜下阑尾切除术可推荐应用于有高危手术风险因素的阑尾炎患者人群。
목적：탐토복강경하란미절제술대위술기존재고위수술풍험적복잡성란미염환자적료효。방법회고성분석2009년지2014년행란미절제술적소유환자,술전ASA평분위3화4적복잡성란미염환자입선,분위량조：개복란미절제조( open appendectomy,OA)、복강경하란미절제조( LA)。회고성분석량조환자수술시간、주원시간、술후병발증발생솔급염증지표적동태변화。결과 LA조여OA조상비,수술시간경도연장(P<0.05),단주원시간축단(P<0.05)。술후근거Clavien Dindo표준평고병발증발생솔,LA조경미병발증상대교다,단OA조엄중병발증칙상대교다(P<0.01)。 OA조술후WBC치축점하강,이LA조강저연지(P=0.03)；OA조CPR술후경도승고후재강저,이LA조축점은정하강(P<0.05)。결론복강경하란미절제술가추천응용우유고위수술풍험인소적란미염환자인군。
Objective To investigate the effect of laparoscopic appendectomy on patients with high operative risk factors of complicate appendicitis. Methods The patients who underwent appendectomy among 2009 and 2014 were ana-lyzed retrospectively. Patients were classified according to their preoperative risk ( classification of the American Society of Anesthesia-ASA score) . Only patients with ASA 3 and 4 were included and were divided into two groups-open appendecto-my ( OA group) and laparoscopic appendectomy ( LA group) . Results The operation time was slightly longer in the LA group (P<0. 05), but hospital stay was shorter (P<0. 05). Complications graded according to the Clavien Dindo classifi-cation were slightly more frequent in patients after LA, whereas severe complications occurred more frequently in patients after OA (P<0. 01). The postoperative WBC decreased steadily and significantly in patients after OA, whereas the de-crease in patients after LA was delayed (P=0. 03). CRP slightly increased after OA and decreased thereafter, whereas it steadily decreased after LA (P < 0. 05). Conclusions Laparoscopic appendectomy can be recommended for patients with complicated appendicitis even with higher risk categories.