基层医院开展腹腔镜手术的初步体会.DOCVIP

临床医学论文-基层医院开展腹腔镜手术的初步体会 【摘要】? 　　目的：总结基层医院开展腹腔镜手术的经验和体会。方法：回顾性分析我院普通外科自2004年10月至2007年4月开展的94例各类腹腔镜手术的临床资料。结果：94例中包括腹腔镜胆囊切除术50例（2例因肝囊肿行腹腔镜联合肝囊肿开窗引流术），腹腔镜消化道穿孔修补2例，腹腔镜阑尾切除术40例，腹腔探查2例；5例中转开腹，余均获成功,痊愈出院，无死亡病例及严重并发症发生。结论：严格选择病例、遵循腹腔镜手术原则并掌握一定的操作技巧是基层医院开展腹腔镜手术的关键。 【关键词】? 腹腔镜术　医院　基层　病例报告 　　The initial experience of laparoscopic surgery in primary hospital:a report of 94 cases??? 　　【Abstract】Ｏbjective:To summarize the initial experience of laparoscopic surgeries in primary hospital.Methods:The data of 94 cases underwent laparoscopic operation from October 2004 to April 2007 in our hospital was retrospectively analyzed.Results:Nintyfour laparoscopic operations included 50 cases of laparoscopic cholecystectomy,2 cases of laparoscopic repair of alimentary tract perforation,40 cases of laparoscopic appendectomy and 2 cases of laparoscopic exploration of abdominol cavity.Among 94 cases 2 with hepatic cyst underwent combined laparoscopic fenestration.There were 5 cases converted to open procedure and the remaining patients experienced successful laparoscopic operations.All patients recovered well and discharged without mortality and severe complications.Conclusions:The critical factors to develop laparoscopic surgeries in primary hospital include selecting indications strickly,observing the principle of laparoscopic operation and mastering corresponding technique and skills.??? 　　【Key words】? Laparoscopy;Hospital,primary;Case report ??? 自2004年10月至2007年4月，我院共开展各类腹腔镜手术94例，疗效满意，现报道如下。 　　1? 资料与方法 　　1.1? 临床资料? 　　94例中男48例，女46例，18～91岁，平均43.6岁。其中腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)５０例中急性胆囊炎９例，胆囊腺肌病2例，胆囊息肉癌变1例，慢性胆囊炎3８例（3例为多次发作胆源性胰腺炎）；腹腔镜消化道穿孔修补术2例；腹腔镜阑尾切除术(laparoscopic appendectomy,LA)４０例，其中急性阑尾炎22例，慢性阑尾炎14例，阑尾周围脓肿4例；腹腔探查治疗肠梗阻2例。其中3例联合手术，2例腹腔镜胆囊切除＋肝囊肿开窗引流术，1例腹腔镜阑尾切除＋肝囊肿开窗引流术；有上腹部手术史2例，合并肝硬化2例，心脏疾病6例，慢性阻塞性肺疾病1例，糖尿病1例，围手术期口服阿司匹林2例。 　　1.2? 手术方法? 　　ＬＣ、消化道穿孔修补术、腹腔探查术均采用气管插管全身麻醉，早期7例ＬＡ也采用气管插管全身麻醉，但患者花费高，后期操作熟练，手术时间缩短后，改为连续硬膜外麻醉或者腰硬联合麻醉。所行手术步骤均与文献［１］一致。对有上腹部手术史行ＬＣ的患者， Trocar穿刺、气腹建立以及随后