坏疽、化脓性阑尾炎合并穿孔的腹腔镜治疗.docxVIP

坏疽、化脓性阑尾炎合并穿孔的腹腔 镜治疗 【摘要】 目的：探讨腹腔镜阑尾切除 术(laparoscopic appendectomy,LA) 治疗坏 疽、化脓性阑尾炎合并穿孔的安全性和可行 性。方法：总结 2002年1月至2007年12 月应用LA治疗93例坏疽、化脓性阑尾炎合 并穿孔患者的临床资料， 术中处理阑尾根部 时，使用Endo loop阑尾根部双重套扎或 双重钛夹夹闭46例，直接腹腔镜下丝线打 结阑尾根部23例，间断缝合阑尾残端加医 用生物蛋白胶覆盖15例，清除阑尾残余组 织加医用生物蛋白胶覆盖残端， 放置硅胶引 流管9例。结果：93例手术均获成功，无中 转开腹，平均手术时间 72min,术后排气时 间22.5h, 11例术后使用止痛药或止痛针， 1例戳口感染，无肠漏及腹腔脓肿发生，平 均住院5d。结论：随着腹腔镜技术的不断成 熟、完善，对于坏疽、化脓性阑尾炎合并穿 孔患者行LA是安全可行的，具有患者创伤 小、痛苦轻、疤痕小、康复快、并发症少等 优点。 【关键词】 阑尾炎；坏疽；穿孔；阑尾切 除术；腹腔镜术 [Abstract 】O bjective:To explore the feasibility and safety of laparoscopic appendectomy for gangrenous suppurative perforative :Ninety three patients with root gangrenous perforative appendicitis were treated with laparoscopic appendectomy from to ,and the clinic data were dealing with the appendical root,46 cases were used double Endo loop to ligate the appendical root or double titanium clips clipping,23 cases were directly used laparoscopic appendectomy to knot the appendical root,15 cases were used the interrupted suture appendectomy stump and fibrin glue coverage,9 cases of appendical remnant tissue were removed,covered with fibrin glue and placed silica drainge :All operations were successful and no one had mean operative time was 72min,the exhaust time was hours after cases were treated with analesic after case had pore case appeared residual abscess and colic mean time for hospitalization was 5 :Laparoscopic appendectomy for gangrenous suppurative perforative appendicitis is safe and feasible with advantages of minimal invasive,less scar,rapid recovery,fewer complications and so on. 【Key words 】 Appendicitis;Gangrene;Perforation;App endectomy;Laparoscopy 2002年1月至2007年12月我院为93例根 部坏疽、化脓性阑尾炎合并穿孔患者施行腹 腔镜阑尾切除术(laparoscopic appendectomy,LA),均取得成功，现报道如 下。 1资料与方法 1 . 1临床资料本组93例中男57例，女 36例，16?82岁，平均36岁，病史3?16h , 有腹部手术史7例，妇科手术史6例，高 血压、冠心病、糖尿病史 9例，腹腔镜探查 均为坏疽、化脓性阑尾炎合并穿孔，术后病 理诊断与术中所见相符。 1 . 2手术方法硬膜外麻醉+强化或气管插 管全麻，在脐上或脐下做长1cm的弧形切口， 建气腹，气腹压力为13?15mmHg,插入10mm Trocar，直视下在左下腹合适部位置 10mm Trocar，于麦氏点附近置 5mnTrocar。首先 探查，将