超声刀及电刀在腹腔镜阑尾切除术中临床探究.docVIP

超声刀及电刀在腹腔镜阑尾切除术中临床探究 　 【摘要】 目的 比较超声刀与高频电刀在腹腔镜阑尾切除术﹙LA﹚的疗效。方法 分析2005 ～3 ～ 2010 ～ 8 LA 657例。其中用超声刀行LA 429例为超声刀组,电刀行LA 435例为对照组。分别比较两组的手术时间、术中出血量、术后引流量、术后排气时间、住院天数、住院期间总费用。结果 超声刀组手术时间、术中出血量明显低于对照组(P＜0.001), 差异有统计学意义。对照组住院期间总费用低于超声刀组(P＜0.001)，差异有统计学意义。术后引流量、住院天数、术后肛门排气时间差异无统计学意义(P﹥0.05)。结论 用超声刀在LA中要优于电刀，但费用偏高。 【关键词】 腹腔镜阑尾切除术 超声刀 电刀 【Abstract】 Objective To compare the curative effect of Laparoscopic appendectomy when using the harmonic scalpel (HS) vs Electrical knife. Methods From March 2005 to August 2010LA 657 patients with appendicitis were operated. 429 patients and 435 patients underwent appendectomies with HS or Electrical knife respectively. The operative time, intraoperative bleeding volume, postoperative drainage volume, postoperative exhaust time, hospitalization days and total expenses during hospitalization were compared. Results　 The operative time, intraoperative bleeding volume in HS group were significantly lower than those of electrical knife group(P＜0.001). Total expenses during hospitalization in electrical knife group were significantly lower than those of HS group(P＜0.001). Postoperative drainage volume, postoperative exhaust time, hospitalization days showed no significant difference between the HS and electrical knife group (Pgt;0.05).Conclusion HS provides significant advantages over electrical knife in LA, but the cost is on the high side. 【Key words】 LA HS Electrical knife 超声刀是上世纪80年代末期在国外开始应用于外科手术的一种新的医疗器具[1]。最初用于胆囊切除术。除切割性能良好外，其突出优点是止血效果佳[2-3]。随着腔镜技术的发展，国内越来越多的医院开始将其用于外科手术中。现分析如下。 1 资料和方法 1.1一般资料 LA 657例。男326例,女331例,年龄16～78岁,平均47岁。其中急性单纯性阑尾炎87例,急性化脓性阑尾炎298例,急性坏疽性阑尾炎103例,急性化脓穿孔性阑尾炎127例,慢性阑尾炎急性发作23例,慢性阑尾炎19例,超声刀组429例和电刀组435例。 1.2 方法 硬膜外麻醉或全身麻醉。患者取平卧位、头低脚高、轻度左侧卧位。脐下10mm穿刺孔,耻骨联合上方左侧5mm穿刺孔,耻骨联合上方右侧5mm(距麦氏点约5cm)穿刺孔。脐下缘切开10mm切口人造气腹,将气腹压力设定在10～12mmHg。将10mm Trocar插入腹腔内,置入腹腔镜。直视下插入另两个Trocar。 1.2.1超声刀组：找到阑尾后,用一把抓钳夹住阑尾尖端系膜边缘,提起阑尾,用超声刀夹住阑尾系膜凝固切断至阑尾根部,沿阑尾边沿切断系膜则有利于阑尾的取出[4]。对较大的阑尾动脉先用小功率3档凝固至蜡黄色后再离断,保证充分止血。先用分离钳轻夹阑尾根部,以挤压开该部可能存在的粪石，4号双丝线