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假设所有年龄段儿童腹腔镜阑尾切除术(LA)与开放式阑尾切除术(OA)结果相似。设计出院摘要数据回顾性定群研究。设施南加利福尼亚12家地区医院。病人因急性阑尾炎行阑尾切除术的7 650例病人(LA=3 551,OA=4099)。干预 LA或OA。主要结果测量 30-日发病率(伤口感染、脓肿引流和再次住院)和住院期。结果腹腔镜的使用从1998年的22%上升至2007年的70%。总体,LA病人的年龄要长〔平均(SD)年龄12.8(3.2)vs.10.4(3.7)岁〕,P<0.001;穿孔率要低(24%vs.34%;P<0.001)。多变量逻辑回归模式证实,LA与OA比较,优势比要小:伤口感染〔OR=0.6;95%CI(0.5,0.8)〕;脓性引流〔OR=0.6;95%CI(0.4,0.7)〕。多变量线性回归模式也显示,与OA比较,LA住院期要短。结论目前儿童阑尾炎优选术式,与OA比较,LA与伤口感染、脓肿引流风险和住院期短相关。
It is assumed that laparoscopic appendectomy (LA) in children of all ages is similar to open appendectomy (OA). Design summary data for retrospective population study. Facilities Southern California 12 regional hospitals. 7650 patients (LA = 3551, OA = 4099) underwent appendectomy for acute appendicitis. Intervention with LA or OA. The primary outcome measures the 30-day morbidity (wound infection, abscess drainage and rehospitalization) and hospitalization. Results The use of laparoscopy increased from 22% in 1998 to 70% in 2007. Overall, patients with LA had longer ages (mean SD 12.8 (3.2) vs. 10.4 (3.7) years), P <0.001, and perforation rates were lower (24% vs. 34%; P <0.001). Multivariate logistic regression models confirmed that odds ratios were smaller for LA versus OA: wound infection [OR = 0.6; 95% CI (0.5,0.8)]; purulent drainage [OR = 0.6; 95% CI ]. Multivariate linear regression model also showed that compared with OA, LA hospitalization period should be short. Conclusions The best surgical procedure for appendicitis in children is present. Compared with OA, LA is associated with wound infection, risk of drainage of abscess and short hospitalization.