摘要目的：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。

abstractsObjective 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.