پديد آورندگان :
قربانپور، منوچهر دانشگاه علوم پزشكي همدان - بيمارستان بعثت - بخش جراحي عمومي - گروه جراحي عمومي , درخشانفر، امير دانشگاه علوم پزشكي همدان - بيمارستان بعثت - بخش جراحي عمومي - گروه جراحي عمومي , نيايش، امين دانشگاه علوم پزشكي همدان - بيمارستان بعثت - بخش جراحي عمومي , اسكندرلو، مهدي دانشگاه علوم پزشكي همدان - بيمارستان بعثت - بخش جراحي عمومي - گروه جراحي عمومي
چكيده فارسي :
ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺁﭘﺎﻧﺪﻳﺴﻴﺖ ﺣﺎﺩ ﻳﻜﻲ ﺍﺯ ﺷﺎﻳﻌﺘﺮﻳﻦ ﺍﻭﺭﮊﺍﻧﺲﻫﺎﻱ ﺟﺮﺍﺣﻲ ﺍﺳﺖ. ﻫﺮﭼﻨﺪ ﺑﻴﺸﺘﺮ ﺍﺯ 20 ﺳﺎﻝ ﺍﺯ ﺍﻧﺠﺎﻡ ﺁﭘﺎﻧﺪﮐﺘﻮﻣﻲ ﻻﭘﺎﺭﺍﺳﮑﻮﭘﻴﮏ ﻣﻲﮔﺬﺭﺩ، ﺗﻮﺍﻓﻘﻲ ﺩﺭ ﺯﻣﻴﻨﻪ ﻣﺰﺍﻳﺎ ﻭ ﻣﻌﺎﻳﺐ ﺁﻥ ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﺭﻭﺵ ﻣﻌﻤﻮﻝ ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ. ﺗﻌﺪﺍﺩﻱ ﺍﺯ ﻣﻄﺎﻟﻌﺎﺕ ﺍﺧﻴﺮ ﺑﺮﺗﺮﻱ ﺭﻭﺵ ﻻﭘﺎﺭﺍﺳﮑﻮﭘﻴﮏ ﺭﺍ ﺍﺯ ﻧﻈﺮ ﻃﻮﻝ ﻣﺪﺕ ﺍﻗﺎﻣﺖ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ، ﺩﺭﺩ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﻭ ﻋﻮﺍﺭﺽ ﻋﻔﻮﻧﻲ ﻧﺸﺎﻥ ﺩﺍﺩﻩﺍﻧﺪ. ﺍﻳﻦ ﻳﺎﻓﺘﻪﻫﺎ ﺗﻮﺳﻂ ﺑﺮﺧﻲ ﻣﻄﺎﻟﻌﺎﺕ ﺩﻳﮕﺮ ﮐﻪ ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭﻱ ﺭﺍ ﺑﻴﻦ ﺩﻭ ﺭﻭﺵ ﻧﺸﺎﻥ ﻧﺪﺍﺩﻩﺍﻧﺪ ﺑﻪ ﭼﺎﻟﺶ
ﮐﺸﻴﺪﻩ ﺷﺪﻩﺍﻧﺪ. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪﻑ ﻣﻘﺎﻳﺴﻪ ﺁﭘﺎﻧﺪﮐﺘﻮﻣﻲ ﻻﭘﺎﺭﺍﺳﮑﻮﭘﻴﮏ ﺑﺎ ﺭﻭﺵ ﺑﺎﺯ ﺩﺭ ﺩﺭﻣﺎﻥ ﺁﭘﺎﻧﺪﻳﺴﻴﺖ ﺣﺎﺩ ﺍﻧﺠﺎﻡ ﺷﺪ.
ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: 70 ﺑﻴﻤﺎﺭ ﻣﺒﺘﻼ ﺑﻪ ﺁﭘﺎﻧﺪﻳﺴﻴﺖ ﮐﻪ ﺑﺮﺍﻱ ﺩﺭﻣﺎﻥ ﺟﺮﺍﺣﻲ ﺑﻪ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺑﻌﺜﺖ ﻫﻤﺪﺍﻥ ﺍﺭﺟﺎﻉ ﺷﺪﻩ ﺑﻮﺩﻧﺪ، ﺑﻄﻮﺭ ﺗﺼﺎﺩﻓﻲ ﺩﺭ ﺩﻭ ﮔﺮﻭﻩ 35 ﻧﻔﺮﻩ )ﮔﺮﻭﻩ A ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﺁﭘﺎﻧﺪﮐﺘﻮﻣﻲ ﺑﺎﺯ ﻭ ﮔﺮﻭﻩ B ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﺁﭘﺎﻧﺪﮐﺘﻮﻣﻲ ﻻﭘﺎﺭﺍﺳﮑﻮﭘﻴﮏ( ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﻣﻮﺍﺭﺩ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺷﺎﻣﻞ ﺳﻦ ﻭ ﺟﻨﺲ ﺑﻴﻤﺎﺭﺍﻥ، ﻃﻮﻝ ﻣﺪﺕ ﻋﻤﻞ )ﺍﺯ ﺯﻣﺎﻥ ﺍﻧﺴﺰﻳﻮﻥ ﭘﻮﺳﺘﻲ ﺗﺎ ﺯﻣﺎﻥ ﺑﺴﺘﻦ ﺯﺧﻢ(، ﺩﺭﺩ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ، ﻃﻮﻝ ﻣﺪﺕ ﺍﻗﺎﻣﺖ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ، ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﻓﻌﺎﻟﻴﺖﻫﺎﻱ ﻋﺎﺩﻱ ﻭ
ﻋﻮﺍﺭﺽ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺑﻮﺩﻧﺪ. ﺗﺠﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﺍﻃﻼﻋﺎﺕ ﺑﻪ ﮐﻤﮏ ﻧﺮﻡ ﺍﻓﺰﺍﺭ ﺁﻣﺎﺭﻱ SPSS ﻭﻳﺮﺍﻳﺶ 17 ﺍﻧﺠﺎﻡ ﺷﺪ.
ﻳﺎﻓﺘﻪ ﻫﺎ: ﺍﺧﺘﻼﻑ ﻣﻌﻨﻲﺩﺍﺭﻱ ﺑﻴﻦ ﺩﻭ ﮔﺮﻭﻩ ﺍﺯ ﻧﻈﺮ ﺳﻨﻲ ﻭ ﺟﻨﺴﻲ ﻭﺟﻮﺩ ﻧﺪﺍﺷﺖ. ﻣﻴﺎﻧﮕﻴـﻦ ﻃﻮﻝ ﻣﺪﺕ ﻋﻤﻞ ﺩﺭ ﺩﻭ ﮔﺮﻭﻩ ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭﻱ ﺩﺍﺷﺖ )35/71±16/09 ﺩﻗﻴﻘﻪ ﺩﺭ ﮔﺮﻭﻩ ﺑﺎﺯ ﻭ 54/42±17/14 ﺩﻗﻴﻘﻪ ﺩﺭ ﮔﺮﻭﻩ ﻻﭘﺎﺭﺍﺳﮑﻮﭘﻴﮏ، 0/032=P(. ﻫﻤﭽﻨﻴﻦ ﺗﻔﺎﻭﺕ ﻃﻮﻝ ﻣﺪﺕ ﺍﻗﺎﻣﺖ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺩﺭ ﺩﻭ ﮔﺮﻭﻩ ﻧﻴﺰ ﺍﺯ ﻧﻈﺮ ﺁﻣﺎﺭﻱ ﻣﻌﻨﻲﺩﺍﺭ ﺑﻮﺩ 54/77±27/02 ﺳﺎﻋﺖ ﺩﺭ ﮔﺮﻭﻩ ﺑﺎﺯ ﻭ 30/25±11/85 ﺳﺎﻋﺖ ﺩﺭ ﮔﺮﻭﻩ ﻻﭘﺎﺭﺍﺳﮑﻮﭘﻴﮏ، )P<0.001(. ﻣﻴﺰﺍﻥ ﻋﻔﻮﻧﺖ ﺩﺭ ﮔﺮﻭﻩ ﺁﭘﺎﻧﺪﮐﺘﻮﻣﻲ ﺑﺎﺯ ﺑﻄﻮﺭ ﻣﻌﻨﻲﺩﺍﺭﻱ ﺑﺎﻻﺗﺮ ﺍﺯ ﮔﺮﻭﻩ ﻻﭘﺎﺭﺍﺳﮑﻮﭘﻴﮏ ﺑﻮﺩ )14/3 ﺩﺭ ﮔﺮﻭﻩ ﻻﭘﺎﺭﺍﺳﮑﻮﭘﻴﮏ، 0/027=P(. ﻣﺪﺕ ﺯﻣﺎﻥ ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﮐﺎﺭ ﺩﺭ ﮔﺮﻭﻩ ﺑﺎﺯ، 7/8 ﺭﻭﺯ ﻭ ﺩﺭ ﮔﺮﻭﻩ ﻻﭘﺎﺭﺍﺳﮑﻮﭘﻴﮏ 5/22 ﺭﻭﺯ ﺑﻮﺩ )P<0.001(. ﻫﻤﭽﻨﻴﻦ ﻣﻴﺎﻧﮕﻴﻦ ﺩﻭﺯ ﻣﺼﺮﻓﻲ ﻣﺴﮑﻦ ﺩﺭ ﺩﻭ ﮔﺮﻭﻩ ﺑﻄﻮﺭ ﻣﻌﻨﻲﺩﺍﺭﻱ ﻣﺘﻔﺎﻭﺕ ﺑﻮﺩ
)0/027=P(.
ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺮﺗﺮﻱ ﺭﻭﺵ ﻻﭘﺎﺭﺍﺳﮑﻮﭘﻴﮏ ﺑﺮ ﺭﻭﺵ ﺑﺎﺯ ﺭﺍ ﺍﺯ ﻧﻈﺮ ﻃﻮﻝ ﻣﺪﺕ ﺍﻗﺎﻣﺖ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ، ﺩﺭﺩ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ، ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﮐﺎﺭ ﻭ ﻋﻔﻮﻧﺖ
چكيده لاتين :
Introduction & Objective: Acute appendicitis is one of the most common problems requiring
emergency surgery. Although more than 20 years has elapsed since the introduction of laparoscopic
appendectomy, there is no consensus on its advantages and disadvantages compared to the conventional
technique. Recent studies have shown significant advantages of laparoscopic appendectomy with respect to
the length of hospital stay, postoperative pain and infectious complications. These findings have been
challenged by other authors who observed no significant differences in the outcome between the two
procedures. In the present study, we aimed to compare the laparoscopic approach and the open technique in
the treatment of acute appendicitis.
Materials & Methods: 70 patients with diagnosis of acute appendicitis, who referred to Besat Hospital
of Hamadan, were included in this study. They were randomly divided into two groups of 35 patients, One
group underwent Open appendectomy (group A), and the other group, had laparoscopic appendectomy (group
B). The parameters examined in this study included patient’s characteristics (age, sex), operation time (from
skin incision to wound closure), postoperative pain, length of hospital stay, return to work and postoperative
complications. The data were analyzed by the SPSS 17 software.
Results: There were no significant differences between two groups with respect to gender and age. The
mean operation time was significantly different in the two groups (it was 55.71 ± 16.09 min in the open group
vs 64.42 ± 17.14 min in the laparoscopic group; P = 0.032). Also the length of hospital stay time was
significantly different in the two groups (54.77 ± 27.02 hours in the open group vs 30.25 ± 11.85 hours in the
laparoscopic group; P < 0.001). Open appendectomy was associated with a significantly higher incidence of
wound infection compared with the laparoscopic group (14.3% vs 0%; P = 0.027).Patients went back to work
7.8 days after their operation in open group, and 5.22 days after their operation in the laparoscopic group (P <
0.001). Also, the average dose of patient’s requirements for analgesia, with pain after surgical treatment, was
significantly different in the two groups (P = 0.027).
Conclusions: In the present study, we were able to demonstrate the superiority of the laparoscopic
approach in terms of hospital stay , postoperative pain , return to work and wound infection.
