腹腔镜阑尾切除术的研究现状与进展

Research Status and Progress of Laparoscopic Appendectomy

摘要: 腹腔镜阑尾切除术(Laparoscopic appendectomy, LA)作为一种微创手术方式，较传统开腹阑尾切除术(Open appendectomy, OA)具有创伤小、术后恢复快等优势。随着设备与技术的不断进步，LA已成为急性阑尾炎的主流治疗手段。然而，其在特殊病情(如阑尾周围脓肿、妊娠期阑尾炎等)、术式选择(如SILA、NOTES)、术后疼痛管理及成本效益等方面仍存在诸多争议与优化空间。本文旨在系统综述LA的研究现状与最新进展，重点剖析目前存在争议的临床问题，评估不同术式的真实效益，探讨快速康复外科(ERAS)理念及区域神经阻滞等疼痛管理新策略在LA中的应用，并提出未来研究方向与临床实践建议，以期为LA的规范化、个体化应用提供理论依据。

Abstract: Laparoscopic appendectomy (LA), as a minimally invasive surgical approach, offers advantages such as reduced trauma and faster postoperative recovery compared to traditional open appendectomy (OA). With the continuous advancement of equipment and techniques, LA has become the mainstream treatment for acute appendicitis. However, there remain numerous controversies and areas for optimization in special conditions (such as periappendiceal abscess, pregnancy-related appendicitis), surgical technique selection (such as single-incision LA, Natural Orifice Transluminal Endoscopic Surgery—NOTES), postoperative pain management, and cost-effectiveness. This article aims to systematically review the current research status and latest progress of LA, with a focus on analyzing currently controversial clinical issues, evaluating the true benefits of different surgical techniques, exploring the application of Enhanced Recovery after Surgery (ERAS) concepts and new pain management strategies such as regional nerve blockade in LA, and proposing future research directions and clinical practice recommendations. The goal is to provide a theoretical basis for the standardized and individualized application of LA.