Efficacy Evaluation Of Endoscopic Retrograde Appendicitis Therapy On Acute Uncomplicated Appendicitis

Background:Acute appendicitis is a common type of acute abdominal pain in emergency surgery,whose first treatment is surgical resection.However,with further understanding and exploration of the function of the appendix,clinical studies have confirmed that the appendix plays a critical role in the immune function of the human intestine.Therefore,some scholars believe that the surgical resection of acute uncomplicated appendicitis is unnecessary.With the continuous advancement of endoscopic technology,the treatment of endoscopic retrograde appendicitis therapy(ERAT)which has the advantages of retaining appendix function,minimally invasive etc is gradually recognized by clinicians.Purpose:To analyze the clinical value of endoscopic retrograde appendicitis therapy in the treatment of acute uncomplicated appendicitis retrospectively by comparing with laparoscopy appendectomy(LA).Materials and Methods:Case data of patients with acute uncomplicated appendicitis admitted to the First Affiliated Hospital of Henan University from December 2017 to January 2019 were collected.The patients were divided into the laparoscopy group(the LA group)and the endoscopic group(the ERAT group)on the basis of the treatment methods.We compare the demographic data,the preoperative situation,the interpretative situation,the postoperative recovery,the length of stay,hospitalization expenses and postoperative complications between the two groups.Result:A total of 143 cases were collected in this retrospective study,and 104 cases were included after screening by inclusion and exclusion criteria,including 60 patients in the LA group and 44 patients in the ERAT group.1.Comparison of preoperative dataThere were not any statistically significant differences in the term of age,sex,height,weight,onset time,admission temperature,abdominal pain score(VAS score),inflammatory indicators andcomplications between the two groups(P>0.05).2.Comparison of Intraoperative situationDuration of operation in ERAT group(45.20±7.15min)was less than that in LA group(61.25±8.27min),and there was significant difference between them(P<0.05).There were not any operative complications(such as bleeding and perforation)in the two groups.3.Comparison of postoperative recovery3.1 Recovery of clinical symptoms:Postoperative abdominal pain(VAS score)in both groups was less than that before the operation,and the abdominal pain score was lower within 24 hours after the operation than within 6 hours after the operation.The proportions of VAS score at 6 hours(ERAT=36.3% vs LA=16.74%)and 24 hours(ERAT=56.8% vs LA=28.3%)after surgery who was below 3 were greater in the ERAT group than in LA group.The time needed for the body temperature to return to normal in ERAT group(ERAT=1.27±0.90 d vs LA=1.72±1.09d)was shorter than that in the LA group.Besides,it is unnecessary to stay in bed continuously after surgery in ERAT group,and the difference was statistically significant(P<0.05).3.2 Recovery of inflammatory markers:The inflammatory index of ERAT group was better than that of LA group on the first day(white blood cell count : ERAT=45.5% vs LA=26.7%,neutrophil ratio:ERAT=52.3% vs LA=28.3%,C-Reactive Protein level: ERAT=34.1% vs LA=15.0%)and the third day(white blood cell count : ERAT=93.2% vs LA=78.3%,neutrophil ratio: ERAT=97.7% vs LA=81.7%,C-Reactive Protein level: ERAT=70.5% vs LA=43.3%)after the operation,The difference was statistically significant(P<0.05).4.Comparison of Hospital stay and costBoth the length of stay(ERAT=3.00±0.86 d vs LA=3.57±0.83d)and the cost of stay(ERAT=9548.14±699.90 yuan vs LA=10549.50±1025.79yuan)in ERAT group were less than those in LA group,and the difference was statistically significant(P<0.05).5.Comparison of postoperative complicationsThere was no statistically significant difference in the incidence of complications within 30 days after surgery(ERAT=0% vs LA=1.49%,P>0.05)between ERAT group and LA group(ERAT=0% vs LA=1.49%,P>0.05),the incidence of intestinal adhesion in ERAT group within 1 year after surgery wasnot statistically significant compared with that in LA group(ERAT=0% vs LA=3.33%,P>0.05),and the recurrence rate of appendicitis within 1 year after surgery was higher in ERAT group than in LA group(ERAT=11.4% vs LA=0 %P<0.05),indicating a statistically significant difference.Conclusions:ERAT is safe and effective for the treatment of acute uncomplicated appendicitis.Compared with LA,patients treated with ERAT have faster recovery,less trauma,shorter hospital stay and less cost,which are worthy of clinical promotion.