用传统方法行腹腔镜阑尾切除可行性探究.docVIP

用传统方法行腹腔镜阑尾切除可行性探究 　 作者：钟立明，彭毅，龙光辉，周晓初，叶建宇，尹耀新，熊沛 【关键词】 阑尾切除术；腹腔镜；缝合打结技术；腹腔内 　　［摘要］目的：探讨腹腔镜下按传统方法切除阑尾的可行性。方法：回顾性分析2005年1月至2006年2月47例腹腔镜阑尾切除术资料，均使用3孔法腔内缝合打结技术，35例阑尾残端结扎后行荷包缝合包埋，另12例阑尾残端单纯结扎后不予包埋。对其术前的临床资料、手术时间、并发症及术后恢复情况进行纪录。结果：全部手术均在腹腔镜下成功完成，残端包埋组手术时间较单纯结扎组明显延长（24.5 min、33.8 min），术后平均住院时间差异无显著性（2.1 d、2.3 d）,未发现伤口感染及腹腔脓肿。结论:腹腔镜下按传统方法处理阑尾是安全可行的。 　　［关键词］ 阑尾切除术；腹腔镜；缝合打结技术；腹腔内　　The Feasibility Study of Laparoscopic Appendectomy in the Traditional Way Department of Laparoscopic Surgery 　　Abstract： Objective To evaluate the feasibility of laparoscopic appendectomy in traditional way. Methods The data of 47 cases of laparoscopic appendectomy during Jan 2005 to Feb.2006 was retrospective analysed. All were completed by 3-trocar and intraperitoneal knotting technique,12 of them the stump of appendecus were simply ligated and the other 35 were ligated and inverted with pursestring suture. The clinical data before and after operation were recorded. Results All the operation were successfully completed under laparoscopy. The operative time of the stump inverted group were significantely longer than the simply ligated group (24.5 vs 33.8 minutes), The inhospital stay after operation were not singnificantly between the two groups (2.1 vs 2.3 days), no wound infection nor abdominal abscess were found. Conclusion Laparoscopic appendectomy in the traditional way feasibility and safe. 　　Key words： Appendectomy；Laparoscopy; Suturing and knotting technique； Intraperitoneal 　　腹腔镜阑尾切除术作为一基本术式已在各地广泛开展。查阅文献及手术图谱，阑尾残端一般只作单纯结扎而不进行包埋［1］，而传统开腹手术在阑尾切除术后均要求行阑尾残端包埋［2］。我们自2005年以来行腹腔镜阑尾切除术时在部分病例按传统开腹方法用荷包缝合包埋阑尾残端，现将我们的手术方法及经验报告如下。 　　1　临床资料 　　自2004年1月至2006年2月共实行腹腔镜阑尾切除术47例，男22例，女27例，平均年龄37.2岁，急性阑尾炎32例（阑尾穿孔5例），慢性阑尾炎15例。12例行阑尾残端单纯结扎，其余35例行阑尾残端结扎后作荷包缝合包埋，两组患者术前一般资料及病例分型差异无显著性。 　　2方法 　　常规腹腔镜手术器械，气管插管全麻，头低脚高卧位，右侧抬高15°，常规按半开放法建立气腹，脐下缘10 mm套管作为观察孔，于右侧腹平脐及脐与耻骨联合连线的中点处各作5 mm或3 mm切口作为操作孔；腹腔镜下探查完毕，决定行阑尾切除后，先游离阑尾周围粘连，暴露阑尾。阑尾系膜的处理：用阑尾钳提起阑尾，于阑尾根部无血管区用电凝钩切开系膜浆膜层，分离钳开窗后带入一段长约6 cm的普通7号丝线，结扎阑尾系膜；阑尾系膜较厚或水肿严重时可先用分离钳钳夹欲