悬吊固定法在腹腔镜阑尾切除术中应用.docVIP

悬吊固定法在腹腔镜阑尾切除术中应用 　 作者：李承青，吴培义，彭德民 【摘要】目的：探讨腹腔镜阑尾切除术（LA）的简易方法。方法：应用悬吊固定法，行三孔法腹腔镜阑尾切除术53例。以2mm细铁丝或带线皮针自腹壁刺入腹腔内，用细铁丝或缝线固定阑尾头部及根部，收紧腹壁外细铁丝或缝线，使阑尾游离端相对固定，然后行阑尾切除术。结果：手术均获成功，无中转开腹，平均手术时间20min，比常规LA缩短10～15min，平均住院3d。结论：悬吊固定法ＬＡ较非固定ＬＡ具有简单易行，手术时间短，安全快捷，避免腹腔内金属异物存留等优点。 　　【关键词】 阑尾切除术，腹腔镜；腔内打结；悬吊固定法 　　Application of the method of endoscopic hanging and fastening in laparoscopic appendectomy 　　【Abstract】Ｏbjective:To explore the easy method of laparoscopic appendectomy (LA) by endoscopic hanging and fastening.Methods:53 patients of the threetrocar LA were performed through endoscopic hanging and fastening method.Punctur the abdominal wall with ２mm iron wires or ligature needles attaching No.4 ligature.Then fastening the head and the root of the appendix with the iron wire or the No.4 ligature and simultaneously tightening the rest part of the iron wire or the No.4 ligature left out side of the abdominal cavity.Thus the free appendix was in a relative stable position,then remove the appendix.Results:All patients were completed by this method in this group,with no conversion to open operation;the mean operative time was 20min which is shorter 10１5min comparing to conventional LA;mean time of hospitalization was 3 days.Conclusions:Employing the method of hanging and fastening in LA has advantages of easy performing,economizing time in operation,safety and reliability,and no titaniumclip in abdominal cavity. 　　【Key words】Appendectomy,laparoscopic;Endoscopic Knotting;Method of hanging and fastening 　　因腹腔镜阑尾切除术（LA）具有创伤小，康复快，还可探查术前诊断不明的外科急腹症等优点，已逐渐成为外科医师和阑尾炎患者首选的术式。2004年9月至１2月我们采用悬吊固定法为53例患者行LA，取得了较好的疗效，现报道如下。 　　１ 资料与方法 　　11 临床资料 　　本组53例中男32例，女21例，7～73岁，平均40岁。术后病理诊断：急性阑尾炎26例，慢性阑尾炎15例，急性化脓性阑尾炎8例，急性坏疽性阑尾炎4例合并穿孔３例，发病时间4～72h。 　　12 手术方法 　　患者取头低足高左侧斜位，采用硬膜外麻醉或腰麻或气管内插管全麻。脐左侧缘作10mm Trocar，造气腹（12～14mm Hg）后置入腹腔镜，在腹腔镜引导下，于脐与耻骨联合连线中点左腹直肌外侧缘作10mm Trocar,为主操作孔；耻骨结节右上方4cm处作5mm Trocar,为辅助操作孔。先全腹探查，吸出脓液或腹腔渗液，找到阑尾，分离与周边的粘连带，直至全阑尾及其系膜完全游离，于辅操作孔旁以2mm细铁丝或带线皮针自腹壁刺入腹腔内，固定阑尾头部及根部，收紧腹壁外细铁丝或缝线，使阑尾完全固定于腹膜上，用分