腹腔镜下阑尾切除术22例临床分析.docVIP

精品论文 参考文献 腹腔镜下阑尾切除术22例临床分析 郑州卷烟厂康复医院外科 450000 简委 　　[Abstract] Objective To summarize the experience of laparoscopic appendectomy. Methods the clinical data of 22 cases of laparoscopic appendectomy were analyzed retrospectively. Results of the 22 cases, 18 cases were performed laparoscopic appendectomy, 2 cases were performed by the drainage of the abscess around the appendix, 2 cases were the appendix root perforation or retroperitoneal laparoscopic appendectomy. 1 cases of postoperative bleeding after operation, 2 cases of incision infection, because no intestinal fistula, intestinal adhesion, intestinal obstruction and reoperation. Conclusion laparoscopic appendectomy to correctly handle the mesangial and appendix removed from the abdominal cavity and can decrease the wound infection, intestinal adhesion, intestinal obstruction in the incidence, the operation especially in obesity, in children and purulent gangrenous appendicitis patients. 　　[Key words] laparoscopic appendectomy appendicitis 　　【摘要】? 目的 总结腹腔镜阑尾切除术的经验。方法 回顾分析行腹腔镜阑尾切除术22例的临床资料。结果 22例中,18例在腹腔镜下完成阑尾切除术,2例行阑尾周围脓肿引流术,2例为阑尾根部穿孔或腹膜后阑尾中转剖腹手术。1例术后出血而再手术,戳孔感染2例,无因肠瘘、肠粘连、肠梗阻而再手术者。结论 腹腔镜阑尾切除术要正确处理系膜并将阑尾移出腹腔,可降低切口感染、肠粘连、肠梗阻的发生率,此术式尤其适用于肥胖,小儿及化脓坏疽性阑尾炎患者。 　　【关键词】　腹腔镜? 阑尾炎? 阑尾切除术 　　我院自2008 年9月开展腹腔镜胆囊切除术,2013 年10月开展腹腔镜系列手术,包括阑尾切除术、肠粘连松解术等。现将2012年10月至2015年12月所施行的腹腔镜阑尾切除术22例的体会报告如下。 　　1 　资料与方法 　　1.1 临床资料　22例中,男16例,女6例,17～59岁。慢性阑尾炎2例,急性单纯性阑尾炎5例,急性化脓性阑尾炎11例,坏疽穿孔性阑尾炎并腹膜炎2 例,阑尾周围脓肿2例。 　　1.2 手术方法　(1) 术前准备:术前常规备皮,留置导尿管或手术前解尽小便,采用气管内插管全麻; (2) 戳孔选择:第1戳孔为脐下缘,形成人工气腹13-14mmHg后放入腹腔镜。在腹腔镜直视下于左髂前上棘内2cm处做0.15cm戳孔为第2戳孔,在耻骨联合上方2cm处做1cm戳孔为第3戳孔; (3)阑尾切除:双极电凝法切除阑尾,患者取头低足高向左侧倾斜位,用无齿抓钳分开大网膜与阑尾粘连的回肠,暴露阑尾系膜,用双极凝器内凝阑尾系膜后,剪断系膜直至阑尾根部。然后用2个Roederprime;s 结在距盲肠013cm及1cm处结扎阑尾,在两套扎线间剪断阑尾,阑尾残端粘膜电灼,不做包埋。 　　如果阑尾尖端与周围粘连不易分离,则先双极电凝阑尾根部，在离盲肠015cm处剪断阑尾后,用可吸收线套扎残端，再逐步处理阑尾系膜,直到分离至尖端。术中如未见阑尾穿孔，只行吸引或用小沙条擦净阑尾周围渗液，不行冲洗，以免炎症扩散，引起术后发热，如见阑尾已形成脓肿，则用血管钳分开脓腔,吸尽脓液后用015%甲哨唑溶液冲洗后放引流管。坏疽穿孔性阑尾炎并弥漫性腹膜炎者,切除阑尾后,用大量盐水及甲硝唑溶液冲洗吸净,于耻骨联合上第3戳孔处放置橡皮引流管; (4) 阑尾移出腹腔:阑尾直径小于1c