천공성 충수염에 있어서 복강경 충수절제술의 의의

Abstract

Laparoscopic appendectomy was developed as an alternative procedure to treat acute appendicitis. There are some arguments about the advantages of laparoscopic, procedures. To assess the advantages of laparoscopic appendectomy in complicated appendicitis, we compared the differences between laparoscopic and open appendectomies in patients with complicated appendicitis. The authors compared the clinical characteristics between eighteen patients of open, and seventeen of laparoscopic, appendectomies in complicated appendicitis (perforated appendicitis and periappendiceal abscess) during an 18 month period. We reviewed medical records and compared the age, sex, symptom duration, operative time, hospital stay, antibiotic usage and postoperative complications between two groups. The mean duration of symptom was 4.4土4.1 days in the laparoscopic group and 2.8士1.5 days in the open group(p>0.05). The mean duration of procedure was 80.0±22.1 minutes in the laparoscopic group and 87.5±24.3 minutes in the open group(p>0.05). The incisions of open appendectomies were low-midline in 7 cases and transverse in 11 cases. All 17 patients in the laparoscopic group were performed by 3 trochars(one of 10mm and two of 5 mm in diameter). The mean duration of hospital stay was 8.9±4.9 days in the laparoscopic group and 7.9 土 4.8 days in the open group(p>0.05). The mean duration of antibiotic coverage was 5.8土2.8 days in the laparoscopic group and 4.8土2.5 days in the open group(p>0.05). The postoperative complications in the open procedures were more frequent than in the laparoscopic group. The complications included 3 cases of wound infection and one case of wound seroma with disruption in the open group, but there was no complications in the laparoscopic group. There were no significant differences in duration of surgery, hospital stay, and duration of antibiotic usage between the two groups. Postoperative complications of the open group were more frequent than the laparoscopic group. There is less chance of contamination of abdominal cavity and incisional wound by laparoscopy, therefore the incidences of wound infection and intraabdominal abscess are low in laparoscopic procedures in complicated appendicitis. The authors conclude that laparoscopic procedures are superior to the open ones in patients with perforated appendicitis or periappendiceal abscess.