Clinical Study Of Laparoscopic Diagnosis And Treatment Of Neonatal Appendicitis

Background and purposeNeonatal appendicitis(NA)is a special type of appendicitis with low incidence but relatively high mortality.Because its clinical manifestations are lack of specificity,it is easy to be misdiagnosed and missed.If it can not be diagnosed and treated in time,it is very easy to be complicated with appendiceal perforation,diffuse peritonitis,formation of periappendiceal abscess and so on.Patients are usually treated with open surgery after diagnosis,and some patients are even diagnosed during exploratory laparotomy.As a special group,newborns often need a long time to recover after laparotomy because their body functions are not yet perfect,which not only brings huge burden to the family and society,also brought the enormous threat to the patient’s life safety.As a minimally invasive treatment,laparoscopy has shown tremendous advantages in adult surgery and has made great strides in pediatric surgery in recent years,with the concept of rapid rehabilitative surgery gaining ground,the Department of Neonatal Surgery at Zhengzhou University is attempting to apply laparoscopic techniques to the diagnosis and treatment of neonatal appendicitis.The purpose of this study was to evaluate the feasibility and safety of laparoscopic appendectomy for neonate appendicitis by comparing the length of hospital stay,time from onset to diagnosis,operative time,postoperative inflammatory index,time of first defecation,time of constant feeding,incidence of complications and satisfaction of parents.Materials and methods1 Research materials and groupingThe clinical data of 42 cases of neonatal appendicitis admitted to the Department of Neonatal Surgery of the third affiliated hospital of the Zhengzhou University from January 2011 to August 2020 were analyzed retrospectively.Among them,25 NA patients who underwent laparotomy were set as the control group,and 17 NA patients who were treated by laparoscopy were set as the observation group.To evaluate the value of laparoscopic appendectomy in the diagnosis and treatment of neonate appendicitis,the general data,operative data and follow-up data of the two groups were analyzed.2 Observation indicators2.1 Preoperative data of control group and observation groupAge,weight,sex,preterm birth,preoperative diagnosis,time from onset to surgery,white blood cell count,CRP level,hemoglobin level and so on.2.2 Intraoperative data of control group and observation groupThe length of incision,the length of operation,the amount of bleeding during operation,the rate of perforation of appendix and so on.2.3 Postoperative data of the control group and observation groupPathological type,first defecation time after operation,constant feeding time after operation,postoperative inflammatory index,postoperative antibiotic use time,complications,total days in hospital,total expenditure in hospital,satisfaction of parents and so on.3 Statistical analysisAll the data in this study were analyzed using SPSS 22.0 statistical software,in which the measurement data were expressed as((?)±s)and the t test was used for comparison,and the counting data were expressed by frequency and rate,and the comparison data were analyzed by χ~2 test.(note: If there is theoretical frequency 1≤T< 5 in χ~2 test,then χ~2 continuous correction formula is used,if there is theoretical frequency T < 1,then Fisher exact probability method is used.)The difference was statistically significant with P < 0.05.Results1 preoperative data of two groupsThere were no statistical difference in age,body weight,sex and preterm delivery between the observation group and the control group.There were no statistical difference in laboratory data such as CRP level,white blood cell count and hemoglobin level between the two groups.The preoperative diagnosis rate in the observation group was lower than that in the control group,and the difference was statistically significant.The time from onset to operation in the observation group was shorter than that in the control group,and the difference was statistically significant.2 Intraoperative data of two groupsThere was no significant difference in operation time between the observation group and the control group.During the operation,the perforation rate of appendix in the observation group was less than that in the control group,the intraoperative blood loss in the observation group was less than that in the control group,and the length of surgical incision in the observation group was less than that in the control group.These differences were statistically significant.3 Postoperative data of two groups According to the pathological type,the proportion of gangrenous appendicitis in the observation group was smaller than that in the control group,and the difference was statistically significant.The time of first defecation after operation,the time of constant feeding after operation and the time of using antibiotics after operation in the observation group were shorter than those in the control group,and the incidence of postoperative complications and the total days of hospitalization in the observation group were shorter than those in the control group,the cost of operation in the Observation Group was higher than that in the control group,and the satisfaction of parents in the observation group was better than that in the control group.Conclusions 1.Both open appendectomy and laparoscopic appendectomy are safe and effective for the treatment of neonate appendicitis,but laparoscopy can be used as a diagnostic tool for the early diagnosis and treatment of NA,the perforation rate of appendix can be reduced to some extent.2.Compared with open appendectomy,laparoscopic appendectomy for NA has the advantages of small incision,short postoperative recovery period and fewer postoperative complications.