Clinical Efficacy of Abdominal Ultrasound-guided Endoscopic Retrograde Appendicitis Therapy for Acute Uncomplicated Appendicitis
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摘要:
目的 利用倾向性评分匹配，评估腹部超声引导内镜下逆行阑尾炎治疗术（endoscopic retrograde appendicitis therapy，ERAT）与腹腔镜阑尾切除术（laparoscopic appendectomy，LA）2种手术方式治疗急性非复杂性阑尾炎的临床疗效。 方法 收集2020年03月至2023年04月云南省第三人民医院收治的441例急性非复杂性阑尾炎患者的病史资料。根据治疗方式差异，将病例分为ERAT组（n = 30）和LA组（n = 411）。采用倾向性评分匹配（propensity score matching，PSM）均衡组间协变量后，比较2组患者的临床疗效。 结果 经过PSM，2组共有30对患者匹配成功，且2组基线资料满足可比性要求。ERAT组术后24 h白细胞、中性粒细胞计数、C反应蛋白水平低于LA组，数据差异均有统计学意义（P < 0.05）。ERAT组手术时间及总有效率相较于LA组，差异无统计学意义（P > 0.05），但ERAT组术中失血量少于LA组，疼痛缓解时间短于LA组，2组之间差异具有统计学意义（P < 0.05）。 结论 腹部超声引导内镜下逆行阑尾炎治疗术效果显著、安全可行，可作为治疗急性阑尾炎切实可行的、有着良好发展前景的无创技术。 -
关键词:
- 腹部超声引导 /
- 内镜下逆行阑尾炎治疗术 /
- 急性非复杂性阑尾炎 /
- 倾向性评分匹配
Abstract:Objective To compare the clinical efficacy of abdominal ultrasound-guided endoscopic retrograde appendicitis therapy （ERAT） with laparoscopic appendectomy （LA） for acute uncomplicated appendicitis using propensity score matching. Methods The clinical data of 441 patients with acute uncomplicated appendicitis admitted to the Third People's Hospital of Yunnan Province from March 2020 to April 2023 were collected. The cases were classified based on the differences in surgical method and divided into the ERAT group （n = 30） and LA group （n = 411）. The clinical efficacy of patients was compared between the two groups after reducing confounding bias by propensity score matching （PSM）. Results After PSM, a total of 30 pairs of patients in the two groups were successfully matched, and the baseline data of the two groups met the requirements for comparability. At 24 hours after the operation, the ERAT group exhibited lower white blood cells, neutrophil counts, and C-reactive protein levels compared to the LA group, and these differences were statistically significant （P < 0.05）. There was no significant difference in the operation time and total effective rate between the ERAT group and the LA group （P > 0.05）. However, the ERAT group had lower intraoperative blood loss and shorter pain relief time compared to the LA group, and these differences were statistically significant （P < 0.05）. Conclusion Abdominal ultrasound-guided endoscopic retrograde appendicitis treatment is an effective, safe, and feasible technique with good prospects for the treatment of acute uncomplicated appendicitis. -
表 1 倾向性评分匹配前后两组患者基线特征 [n（%）/M（Q1，Q3）]
Table 1. The baseline characteristics of the two groups before and after PSM [n（%）/M（Q1，Q3）]
变量 PSM前 PSM后 ERAT组
（n = 30）LA组
（n = 411）χ2/Z P ERAT组
（n = 30）LA组
（n = 30）χ2/Z P 年龄[M（Q1，Q3）岁] 54（33，61） 32（25，49） −3.628 <0.001* 54（33，61） 38（26，24） −0.628 0.534 性别[n（%）] 0.002 0.961 0.000 1.000 男 13（43.3） 180（43.8） 13（43.3） 13（43.3） 女 17（56.7） 231（56.2） 17（56.7） 17（56.7） 合并症[n（%）] 高血压 5（16.7） 31（7.5） 3.105 0.078 5（16.7） 2（6.7） 1.456 0.228 糖尿病 2（6.7） 12（2.9） 1.277 0.258 2（6.7） 2（6.7） 0.000 1.000 冠心病 0（0） 2（0.5） 0.147 0.702 0 0 生活习惯[n（%）] 吸烟 6（20） 68（16.5） 0.239 0.625 6（20） 4（13.3） 0.480 0.488 饮酒 3（10） 36（8.8） 0.053 0.817 3（10） 2（6.7） 0.218 0.640 *P < 0.05。 
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表 2 手术前及术后24 h炎性指标水平比较 [M（Q1，Q3）]
Table 2. Comparison of inflammatory marker levels before and 24 hours after operation [M（Q1，Q3）]
组别 WBC（×109/L） 中性粒细胞计数（×109/L） CRP（mg/L） 手术前 术后24 h 手术前 术后24 h 手术前 术后24 h LA组
（n = 30）9.78
（6.55，13.97）7.01
（5.23，8.12）7.61
（3.98，11.71）4.30
（3.32，6.47）8.30
（4.69，72.21）4.81
（0.80，29.51）ERAT组
（n = 30）10.29
（7.66，14.56）10.13
（8.98，12.08）8.09
（5.06，12.79）8.30
（6.56，10.25）7.29
（1.77，24.46）18.27
（6.92，50.68）Z −1.079 −4.243 −1.109 −4.421 −1.124 −2.575 P 0.280 <0.001* 0.267 <0.001* 0.267 0.010* *P < 0.05。
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表 3 术中情况及手术前后疼痛度比较 [M（Q1，Q3）]
Table 3. Comparison of intraoperative conditions and pain level before and after surgery [M（Q1，Q3）]
组别 ERAT组（n = 30） LA组（n = 30） Z P 手术时间（min） 37（27，62） 50（45，60） 1.863 0.062 术中失血量（mL） 0.0（0.0，0.0） 5.0（5.0，5.0） 5.744 <0.001* VAS 评分 术前 8.0（8.0，9.0） 8.0（8.0，9.0） −0.362 0.696 术后6 h 3.0（2.0，4.0） 6.0（5.0，7.0） 6.490 <0.001* 术后24 h 0.0（0.0，0.0） 2.0（1.0，2.0） 6.047 <0.001* *P < 0.05。
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表 4 2组患者术后第3天手术疗效对比 [n（%）]
Table 4. Comparison of surgical efficacy between the two groups on the third day after operation [n（%）]
组别 n 显效 有效 无效 总有效率（%） ERAT组 30 21（70.0） 9（30.0） 0（0） 100.0 LA组 30 14（46.7） 15（50.0） 1（3.3%） 96.7 χ2 1.017 P 1.000
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[1] Zhang G,Wu B. Meta-analysis of the clinical efficacy of laparoscopic appendectomy in the treatment of acute appendicitis[J]. World J Emerg Surg,2022,17(1):26. doi: 10.1186/s13017-022-00431-1 [2] McCutcheon B A,Chang D C,Marcus L,et al. Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis[J]. J Am Coll Surg,2014,218(5):905-913. doi: 10.1016/j.jamcollsurg.2014.01.003 [3] Dai L,Shuai J. Laparoscopic versus open appendectomy in adults and children: A meta-analysis of randomized controlled trial[J]. United European Gastroenterol J,2017,5(4):542-553. doi: 10.1177/2050640616661931 [4] Zhu J,Li W,Yu K,et al. New strategy during complicated open appendectomy: Convert open operation to laparoscopy[J]. World J Gastroenterol,2014,20(31):10938-10943. doi: 10.3748/wjg.v20.i31.10938 [5] Chung W,Chung S,Hsu C,et al. Risk of inflammatory bowel disease following appendectomy in adulthood[J]. Front Med(Lausanne),2021,8:661752. [6] Randal Bollinger R,Barbas A S,Bush E L,et al. Biofilms in the large bowel suggest an apparent function of the human vermiform appendix[J]. J Theor Biol,2007,249(4):826-831. doi: 10.1016/j.jtbi.2007.08.032 [7] Yang B,Kong L,Ullah S,et al. Endoscopic retrograde appendicitis therapy versus laparoscopic appendectomy for uncomplicated acute appendicitis[J]. Endoscopy,2022,54(8):747-754. doi: 10.1055/a-1737-6381 [8] Cioffi S P,Altomare M,Spota A,et al. REsiDENT 1(Re-assessment of appendicitis evaluation during laparoscopic appendectomy: Do we end a non-standardized treatment approach and habit?): Peritoneal irrigation during laparoscopic appendectomy-does the grade of contamination matter? A prospective multicenter resident-based evaluation of a new classification system[J]. World J Emerg Surg,2019,14:25. doi: 10.1186/s13017-019-0243-4 [9] Vitetta L,Chen J,Clarke S. The vermiform appendix: An immunological organ sustaining a microbiome inoculum[J]. Clin Sci(Lond),2019,133(1):1-8. doi: 10.1042/CS20180956 [10] Cai S,Fan Y,Zhang B,et al. Appendectomy is associated with alteration of human gut bacterial and fungal communities[J]. Front Microbiol,2021,12:724980. doi: 10.3389/fmicb.2021.724980 [11] Tzeng Y,Kao L,Kao S,et al. An appendectomy increases the risk of rheumatoid arthritis: A five-year follow-up study[J]. PLoS One,2015,10(5):e0126816. doi: 10.1371/journal.pone.0126816 [12] Wu S,Chen W,Muo C,et al. Association between appendectomy and subsequent colorectal cancer development: An Asian population study[J]. PLoS One,2015,10(2):e0118411. doi: 10.1371/journal.pone.0118411 [13] Repplinger M D,Weber A C,Pickhardt P J,et al. Trends in the use of medical imaging to diagnose appendicitis at an academic medical center[J]. J Am Coll Radiol,2016,13(9):1050-1056. doi: 10.1016/j.jacr.2016.02.018 [14] Park G,Lee S,Choi B,et al. Stratified computed tomography findings improve diagnostic accuracy for appendicitis[J]. World J Gastroenterol,2014,20(38):13942-13949. doi: 10.3748/wjg.v20.i38.13942 [15] Liu B,Song J,Han F,et al. Endoscopic retrograde appendicitis therapy: a pilot minimally invasive technique(with videos)[J]. Gastrointest Endosc,2012,76(4):862-866. doi: 10.1016/j.gie.2012.05.029 [16] Rosenbaum P R,Rubin D B. The central role of the propensity score in observational studies for causal effects[J]. Biometrika,1983,70(1):41-55. doi: 10.1093/biomet/70.1.41 [17] Huang Y,Zeng M,Zhang L,et al. Dietary inflammatory potential is associated with sarcopenia among chronic kidney disease population[J]. Front Nutr,2022,9:856726. doi: 10.3389/fnut.2022.856726 [18] Bajrami B,Zhu H,Kwak H,et al. G-CSF maintains controlled neutrophil mobilization during acute inflammation by negatively regulating CXCR2 signaling[J]. J Exp Med,2016,213(10):1999-2018. doi: 10.1084/jem.20160393 [19] Jackson S M,Perry L A,Borg C,et al. Prognostic significance of preoperative neutrophil-lymphocyte ratio in vascular surgery: Systematic review and meta-analysis[J]. Vasc Endovascular Surg,2020,54(8):697-706. doi: 10.1177/1538574420951315 [20] Tan T P,Arekapudi A,Metha J,et al. Neutrophil-lymphocyte ratio as predictor of mortality and morbidity in cardiovascular surgery: A systematic review[J]. ANZ J Surg,2015,85(6):414-419. doi: 10.1111/ans.13036 [21] Groeger D S,O'Mahony L,Murphy E F,et al. Bifidobacterium infantis 35624 modulates host inflammatory processes beyond the gut[J]. Gut Microbes,2013,4(4):325-339. doi: 10.4161/gmic.25487 [22] Chow Y,Cheng B,Cheng H,et al. Hong Kong Society of Clinical Blood Management recommendations for implementation of patient blood management[J]. Hong Kong Med J,2020,26(4):331-338. [23] 石明亮,王晓磊,李江琳,等. 内镜逆行阑尾炎治疗术与腹腔镜阑尾切除术在治疗急性阑尾炎中的应用效果比较[J]. 现代医药卫生,2022,38(5):819-822. doi: 10.3969/j.issn.1009-5519.2022.05.024 [24] 黄邵斌,戴银霞,白剑,等. 内镜逆行性阑尾炎治疗术治疗阑尾周围脓肿的疗效分析[J]. 现代消化及介入诊疗,2022,27(10):1292-1295. doi: 10.3969/j.issn.1672-2159.2022.10.013 -
