腹腔镜治疗阑尾炎术中困难的处理和减少术后切口感染的对策.docVIP

精品论文 参考文献 腹腔镜治疗阑尾炎术中困难的处理和减少术后切口感染的对策 朱高勇，贝云枫，陈玉龙 （贺州市人民医院普外科 广西 贺州 542800） 【摘要】目的：总结腹腔镜阑尾切除术中的困难处理对策和术后切口感染的预防经验。方法：回顾性分析2008 年1 月至2012 年10 月我院367 例腹腔镜阑尾 切除术的临床资料。结果：363 例在腹腔镜下顺利完成手术，4 例中转开腹。术中有71 例阑尾处理困难，其中阑尾位置显露困难25 例，系膜出血12 例，阑尾根 部坏疽穿孔15 例，阑尾与周围重度粘连19 例。术后切口感染有7 例，其中急性化脓性阑尾炎2 例，急性穿孔性阑尾炎5 例。结论：熟练的腹腔镜技术和耐心细 致的操作可显著解决腹腔镜阑尾术中遇到的各种困难；充分清洗腹腔和切口及合理选用抗生素可明显降低腹腔镜阑尾术后切口感染的发生。 【关键词】腹腔镜阑尾切除术；术中困难；切口感染 The processing of difficulty and the countermeasure of reducing infections of post-operative incision in laparoscopic surgical treatment for appendicitis Zhu Gaoyong,Bei Yunfeng,Chen Yulong (The general surgery of peoplersquo;s hospital of Hezhou City) [Abstract]Objective:To summarize the processing countermeasure of difficulty and the prevention experience of infections of post-operative incision.Methods:Retrospectively analysed the clinical data of our hospitalrsquo;s 367 laparoscopic appendectomy from Jan. 2008 to Oct. 2012.Result:There were 363 successfully completed surgery in the laparoscopic,and 4 conversion to laparotomy.In surgery there were 71 epityphlon deal with difficult,among these had 25 epityphlon position appeared difficult,12 mesangial bleeding,15 gangrene perforating appendix root,19 the appendix with severe adhesions around.There were 7 infections of post-operative incision,among these had 2 acute suppurative appendicitis,5 acute perforated appendicitis. Conclusion:Skilled natural orifice transumbilical surgery and patience and meticulous operation can observably solve various difficulties in laparoscopic appendix surgery;fully wash enterocoelia and cut and reasonably adopt antibiotic can obviously reduce laparoscopic appendix postoperative incision infection. [Keywords] Laparoscopic appendectomy;Intraoperative difficult;Infection of incisional wound 腹腔镜阑尾切除术已在基层医院广泛开展，且已被列为常规手 术，并以绝对优势替代了开放手术，因腹腔镜阑尾切除术具有住院 时间短、切口感染少等优点，因此，腹腔镜阑尾切除术受到广大普 通外科医师青睐[1]。08 年1 月至12 年10 月我院开展367 例腹腔镜 阑尾切除术，效果良好，但术中困难和术后切口感染仍不可避