作者单位：510700 广州，广州医科大学附属第五医院普通外科(吕会增，叶小勇，陈新岐，张帆，张文海，周如建)； 510630广州，中山大学附属第三医院胃肠外科(魏波)

横切口腹膜外单层缝合与腹腔镜用于阑尾切除的随机对照研究

吕会增魏波叶小勇陈新岐张帆张文海周如建

【摘要】目的比较横切口腹膜外单层缝合和腹腔镜用于阑尾切除术的临床应用效果。方法研究纳入因单纯性阑尾炎或化脓坏疽性阑尾炎切除术而急诊行阑尾切除术的543例患者，随机分为单层缝合组261例和腹腔镜组282例，分别采用横切口腹膜外单层缝合法或腹腔镜阑尾切除术治疗，对2种术式的临床疗效进行对比分析。结果与腹腔镜组比较，单层缝合组的手术时间缩短、术中出血量减少、医疗费用明显降低(P均<0.01)。尽管术后单层缝合组患者的肛门排气时间明显延长(P<0.01)，但其术后疼痛程度、住院时间、切口感染和其他并发症发生率与腹腔镜组比较差异均无统计学意义(P>0.05)。结论应用横切口腹膜外单层缝合术行阑尾切除术具有操作简单、安全、经济的临床特点，可作为阑尾切除的推荐术式。

【关键词】阑尾炎；阑尾切除术；腹膜外单层缝合；腹腔镜技术

DOI：10.3969/g.issn.0253-9802.2015.02.010

基金项目：广东省医学科学技术研究基金(A2010283)

通讯作者，吕会增，E-mail: lvhuizeng@163.com

收稿日期：(2014-09-01)

Randomized controlled trial of transverse abdominal incision sutured by one-layer extraperitoneal closure versus laparoscopic appendectomy in treatment of acute appendicitisLyuHuizeng,WeiBo,YeXiaoyong,ChenXinqi,ZhangFan,ZhangWenhai,ZhouRujian.DepartmentofGeneralSurgery,theFifthAffiliatedHospitalofGuangzhouMedicalUniversity,Guangzhou510700，China

Correspondingauthor,LyuHuizeng,E-mail:lvhuizeng@163.com

Abstract【】ObjectiveTo compare the clinical efficacy of transverse abdominal incision sutured by one-layer extraperitoneal closure and laparoscopic appendectomy in the treatment of acute appendicitis. MethodsIn this randomized controlled study, 543 patients undergoing appendectomy for simplex or suppurative appendicitis were enrolled and randomly divided into groups A and B. In group A, the patients underwent transverse abdominal incision sutured by one-layer extraperitoneal closure (n=261) and those in group B received laparoscopic appendectomy (n=282). The clinical efficacy was statistically compared between two groups. ResultsCompared with their counterparts in group B, patients in group A had significantly shorter operative time, less intraoperative blood loss and lower medical cost (all P<0.01). Postoperative anal exhaust time in group A was significantly longer than that in group B (P<0.01). However, postoperative pain, length of hospital stay, incidence of incisional infection and other complications did not significantly differ between two groups (all P>0.05). ConclusionThe transverse abdominal incision sutured by one-layer extraperitoneal closure is simple, safe and reduces economic cost, which could be regarded as a recomended appendectomy.

【Key words】Appendicitis; Appendectomy; Extraperitoneal one-layer suture; Laparoscopy

急性阑尾炎是普外科最常见急腹症之一，尤其是化脓或坏疽性阑尾炎，首选手术治疗。我们的前期研究显示：与传统麦氏切口分层缝合法比较，横切口腹膜外单层缝合法用于阑尾切除术简单、安全、省时且经济[1]。但与应用腹腔镜行阑尾切除术比较，尚需进一步研究。2010年1月至2013年12月，广州医科大学附属第五医院普外科随机采用横切口腹膜外单层缝合法或应用腹腔镜急诊行阑尾切除术543例，对其临床疗效进行对比分析。……