Source: Chinese Medicine Innovation

Abstract Objective: To compare LA (peritoneal appendectomy) and OA (traditional appendectomy) surgical treatment difference in young patients with appendicitis and to explore the clinical value of the LA. Methods: 261 cases of appendicitis in our hospital were divided into 168 cases of LA group and OA group 93 cases treated with surgery were compared operative time, blood loss, postoperative complications and comprehensive cost of treatment, etc. .

Results: LA group operating in the diagnosis and postoperative complication reduction aspect has obvious advantages. Conclusion: LA group because of its shorter hospital stay, fewer complications, the role of beauty and other advantages will inevitably be more widely used in clinical practice.

Key words of appendicitis; laparoscopic surgery; complications

Appendicitis is the most common surgical diseases, ranking first in the pathogenesis of acute abdomen. Related statistics show that in recent years, its incidence is appearing the increasing trend in our country there are 40-85 people per 1,000 human cases, a few hours after onset showed a typical right lower quadrant pain with tenderness and / or rebound pain symptoms' correct. Currently appendectomy is still the standard treatment for appendicitis [cut. Previous abdominal surgery for appendicitis often used clinically, but with the development of laparoscopic technology continues to progress, more and more clinicians advocate the use of laparoscopic surgery for appendicitis River. Laparoscopic technique, because of its safe, reliable, effective, misdiagnosis rate, to reduce postoperative pain, faster recovery of bowel function and fewer postoperative adhesions and other advantages are widely used oral therapy in Lanna 1 Nepalese inflammation. At present domestic scholars for laparoscopy in children, the elderly, the complexity of the treatment of appendicitis in many reports, but the incidence of more common for appendix young people are rarely reported. In this study were collected in September 2012 --2014 in September hospital surgical treatment appendicitis young people 18-65 years of age, data and information, analyze and summarize the differences with traditional laparoscopic surgical techniques in this population .

Materials and Methods

1.1 General Information under the following conditions in selected cases, inclusion criteria:

(1) patients aged between 18-65 years of age; (2) the mood pulmonary insufficiency, can tolerate surgery; (3) are in the 2-48 h after admission of expert surgery (laparoscopic or traditional surgery) treatment; (4) preoperative or intraoperative diagnosis of appendicitis diagnosed as appendicitis, postoperative pathology have clear support; (5) no other associated diseases; except (6) during hospitalization appendicitis and related complications, but no Other emerging diseases in need of treatment. Exclusion criteria: (1) age <18 or> 65 years: C2) because of contraindications can not tolerate surgery; (3) the appendicitis diagnosis is not clear or no postoperative pathology proved; (4) other diseases at the same time appendectomy persons; (5) failed to complete laparoscopic surgery by laparotomy; (6) found that in the treatment of other diseases, appendicitis and underwent surgical resection; (7) In addition to appendicitis and surgery-related complications and outside the presence of other diseases the need for treatment; (8) without the permission of the treating physician early termination of treatment, from the hospital by = by similar conditions are selected, the cases were selected 261 cases, 172 cases of male, female 89 cases, mean age (39.86 ± 11.54) years; 74 cases of acute appendicitis admitted to hospital, 139 cases of acute exacerbation of chronic appendicitis hospitalized, 48 cases of abdominal pain of unknown origin with peritonitis who underwent surgery after hospital diagnosed as appendicitis; according to the wishes of patients and their families and their own conditions surgical options, 168 routine laparoscopic appendectomy (LA group), 93 cases on routine appendectomy (OA group); pathologically confirmed 50 cases of acute simple appendicitis (19.2%), 20 cases of acute suppurative appendicitis (7.7%), 173 cases of chronic appendicitis (66.30- / 0), gangrenous appendicitis 18 cases (6.9c / o).

1.2 Methods All patients admitted to hospital before surgery according perfect routine laboratory tests, electrocardiogram and chest DR, according to the diagnostic needs to decide whether or exclude the diagnosis of abdominal ultrasound or CT scan; preoperative indwelling catheter. LA Group: select general anesthesia, the establishment of pneumoperitoneum, in the umbilical edge of the arc to make a 1.0 cm incision through this incision into the Veress needle injected intraperitoneally C0: gas, establishment of artificial pneumoperitoneum infusion pressure 12-15 mm Hg. 1 set of people. O cm of Trocar as observation holes and insert 1.0 cm 0 degrees or 30 degrees laparoscopic, abdominal and pelvic exploration, diagnosis. Then the left and right lower abdomen were (generally choose pubic hair distribution area) each placed in a 0.5 cm or 1.0 cm as the operation of Trocar larvae L. Net absorption peritoneal exudate or pus, along the colon to find the appendix, with bipolar coagulation treatment after mesoappendix cut the roots, then 2-0 absorbable suture ligation root of the appendix and other services over the roots of approximately 1.0 cm After the office, at the junction between two lines cut the appendix, electric coagulation hook cautery water disinfection stump, cut the umbilical appendix put specimen bags from the lower abdomen Trocar Trocar or removed, then saline pelvic and abdominal cavity, necessary When placed in the peritoneal drainage tube, the release of gas within the abdominal cavity, pulled Trocar, with the plane pull together the operation hole can be attached to the bottom, with 4-0 absorbable suture umbilical observation hole surgery. After routine use of antibiotics. In addition to the above normal operation i Kong and France, the two-hole method can also be used to operate; in addition, according to appendicitis patients need serious cases, surrounding tissue reactions, edema root of the appendix choose to use silk tie, titanium clip clipping, simple coagulation, ligature, ultrasonic scalpel or ligation methods, etc; It intraperitoneal exudation and the appendix is perforated, gangrenous decide whether to flush the catheter. And strive to complete removal of the appendix, fully closed dead stump, postoperative recovery as soon as possible. OA Group: General Select epidural anesthesia, such as the need Yiyi choose general anesthesia. Take in the right lower quadrant McBurney incisions or laparotomy incision into the abdominal cavity, exploration and clear the peritoneal exudate or pus, to remove the appendix stump embedding, follow the same principles I. A group. After routine use of antibiotics.

1.3 OUTCOME MEASURES surgery patients were mainly observed time, intraoperative blood m, postoperative first flatus time, hospital stay, wound infection rate, home peritoneal drainage rate, incidence of abdominal abscess, intestinal obstruction incidence and total hospital costs.

1.4 Statistical analysis of data with SPSS 13.0 was used for statistical analysis software, measurement data (x + s) that the test was used to compare ￡, count data using 2 test valves to P <0.05 was considered statistically significant.

2 Results

Strictly in accordance with the conditions and exclusion criteria to select candidates, divided according to the collected data nature of the measurement data and count data, measurement data, including surgery when asked, blood loss, postoperative anal exhaust time, hospitalization and hospitalization costs, see Table 1; count data includes the number of cases of wound infection, intestinal obstruction number of cases, the number of cases of postoperative analgesic treatment, intra-abdominal abscess number of cases, the number of cases of postoperative indwelling drainage tube (Table 2).

3 Discussion

Traditional open appendectomy patients with trauma, postoperative recovery time is long, it brings wound infection, abdominal infection, abdominal abscess, intestinal obstruction and other complications often leads to a poor prognosis [6-9]. After White laparoscopic used in clinical treatment, with its trauma, quicker recovery, and less obvious advantages postoperative complications in patients and doctors to be accepted, most of the traditional open surgery has gradually been replaced by laparoscopic surgery, LA operative same We have these advantages. Since the clinical conduct LA surgery, many scholars have made research-related aspects, the report is more of appendicitis in children, the elderly appendicitis, overall research appendicitis during pregnancy or appendicitis, and for more concentrated in the appendix young onset group reports not much. From 261 cases of patient data in this study, LA patients in flatus, bowel obstruction incidence was significantly better than the OA group, the difference was statistically significant (P <0.05), because laparoscopy operation requires the wound is small (average total length of incision of only about 2.6 cm), reducing the chance of bowel exposed to air; and rarely used intraperitoneal saline gauze surgical procedure, reducing the chance of contact with the intestine and fabrics; peritoneal surgery small injury, postoperative without suture the peritoneum. For these reasons greatly avoid the incidence of postoperative intestinal adhesions, rapid recovery of bowel function, an advantage for patients with recent recovery and avoid long-term obstruction it is extremely powerful. In addition, sheep equality '101 that the CO: pneumoperitoneum in the abdominal cavity to create a moist, closed internal environment in which the surface of the abdominal organs, separated from each other, touch each other is one of the reasons fewer opportunities to prevent the occurrence of intestinal adhesions. 5 patients in this study group occurred in LA obstruction or a history of chronic constipation or usual gastrointestinal function, and often occurs bloating; surgery Nvxue case LA group also was significantly higher than OA group superiority, the difference was statistically significance (P <0.05), which is laparoscopic operation the surgeon's field of vision full, open, clearer, and the other also choose to use in laparoscopic surgery more easy hemostatic devices such as ultrasonic scalpel, Absorbable folder and so on. However, due to LA operative operator skill requirements for higher processing bleeding beginner therefore poor skills, this group of patients, I have three cases when the LA operation of more than 50 mL of blood, even more than the OA group surgery The average amount of bleeding; the small incision laparoscopic surgery and chose the way of general anesthesia endotracheal tube to catch, and therefore the ability to tolerate pain patients was significantly better than OA surgery group; the incidence of wound infection, LA were excellent OA group in 168 patients, only 11 cases of wound infection occurred, and laparotomy 93 patients wound infection in 21 cases, the difference was statistically significant (X2 = 12.55, P <0.05). OA Group incision below grade or grade Ⅲ Ⅱ incision appendectomy need removal after removal from the abdominal cavity, the abdominal incision section passes, the latter can not completely avoid contamination of bacteria or pus, which greatly increases the chance of postoperative infection. Further surgery to cut OA group is bound to stretch, squeeze, resulting in tissue incision Edema, making incisions susceptible to infection; and LA operative pneumoperitoneum due to the role, so that propped up the abdominal cavity, so that the source of infection does not contact incision, without the need for additional surgery incision stretch, squeeze; and when LA operative, in appendectomy intra-abdominal pathology bag or extract into the reactor via stamp card larvae L out, avoid direct contact with the opportunity appendix section of the abdominal wall, and therefore the incidence of postoperative infection is greatly reduced. Abdominal abscess drainage and retention were associated with severe cases of inflammation, perforation of the appendix if there is, whether there is abscess formation, regardless of operating LA group or OA group, so the two groups were no significant difference (P> 0.05). But some scholars believe that due to the laparoscopic operation requires head-down, gravy and fluid will flow with the position of each ask gap, which is the reason for the formation of intra-abdominal abscess in LA - [11l. In terms of operation time, the two groups were not statistically significant difference between the cock (P> 0.05), which proficiency with the surgeon, the preoperative severity of inflammation and the ability to deal with complex issues related estimates. On governance crossbow costs, the difference was statistically significant (P <0.05. LA was significantly higher than OA group, which greatly limits the application of LA group on the Pro blink, but the LA group because of its small incision surgery postoperative pain {light, no scar has a cosmetic effect, the ability to work shorter postoperative recovery diagnosis and treatment at the same time avoiding the disadvantages of open surgery, etc., will be more and more evil will be accepted by the majority of doctors and patients '12 - 151. In summary, laparoscopic appendicitis capable of solving problems, the intraoperative diagnosis and operation, to reduce the incidence of postoperative complications t have obvious potential, and because of its shorter hospital stay, fewer complications, the role of beauty and other advantages It is bound to be more widely used in clinical.