A Prospective Clinical Study Of Two Minimally Invasive Surgery In Elderly Patients With Appendicitis

Objective:To compare and summary the advantages of gasless laparoscopic appendectomy versus laparoscopic appendectomy in the treatment of senile appendicitis,providing a rationale for treating senile appendicitis.Method:According to design scheme of prospective controlled study,sixty senile appendicitis?? 60years?planning to receive gasless laparoscopic appendectomy or laparoscopic appendectomy,who were admitted to the No.2 Hospital of Baoding between January 2015 and October 2016,were selected as subjects.All subjects were numbered according to the order of admission.Odd numbers received gasless laparoscopic appendectomy and even numbers received laparoscopic appendectomy were assigned to observation group?30 cases?and control group?30 cases?,respectively.Those subjects enrolled were recorded in Excel regarding baseline data?name,age,type of appendicitis,course of disease,gender,underlying disease,body mass index,etc?and observation index,such as study completion,conversion to open laparotomy,operation success rate,total operative time,intraoperative blood loss,total cost of operation,the first postoperative exhaust time,hospitalization time after the operation complications and pressure of end-tidal CO₂,mean arterial pressure,heart rate at different time points[after anesthesia before establishing CO₂ pneumoperitoneum or overhanging napes?T0?,operation started 15 minutes?T1?,operation started 30 minutes?T2?,15 minutes after removed CO₂ pneumoperitoneum abdominal wall suspension?T3?]and so on.Differences between groups and within groups were compared with SPSS19.0,and there was statistical difference when P<0.05.Results:?1?The baseline data of the two groups were balanced pretty?P>0.05?.?2?patients in observation group were droped out and the other 59 cases were treated with surgery.3 cases were removed in two groups respectively and subjects of 90.00%?54/60?completed the study.The success rate of observation group and control group was approximation?93.10%vs90.00%,P>0.05?.?3?There was no significant difference between the two groups' total operative time,intraoperative blood loss,the first postoperative exhaust time,hospitalization time after the operation?P>0.05?.Total cost of operation in observation group was lower than that in control group?P<0.05?.?4?Pressure of end-tidal CO₂ at T1?T2 time points in observation group was lower than that in control group?P<0.05?.Pressure of end-tidal CO₂ at T1?T2 time points in control group was higher than that at T0 or T3 time points?P<0.05?.Pressure of end-tidal CO₂ at T1 time points in control group was higher than that at T2 time points?P<0.05?.The others comparison of pessure of end-tidal CO₂ between two groups or within groups were comparable?P>0.05?.?5?There was no significant difference of mean arterial pressure and heart rate between groups or within groups?P>0.05?.?6?The overall incidence of complication in observation group was14.81%,2 cases of abdominal discomfort?abdominal distension,abdominal pain,etc?,1 case of vomiting,1 case of abdominal hematoma,1 case of incision infection.The overall incidence of complication in control group was 37.04%,4 cases of abdominal discomfort,3 cases of vomiting,2 cases of shoulder or back pain,2 cases of subcutaneous emphysema.The incidence of abdominal discomfort,vomiting,shoulder or back pain,subcutaneous emphysema in observation group was 7.41%,3.70%,0% and 0%,which were lower than14.81%,11.11%,7.41%,7.41% in control group?P<0.05?,respectively.The observation group's incidence was lower than control group?P<0.05?.Conclusion:Laparoscopic appendectomy is effective in the treatment of appendicitisin elderly patients,and gasless laparoscopic appendectomy has the advantages of low complications and cost.