腹腔镜诊治妊娠合并阑尾炎的临床价值.docVIP

腹腔镜诊治妊娠合并阑尾炎的临床价值 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：腹腔镜诊治妊娠合并阑尾炎的临床价值 1 1 资料与方法 2 文2：盆腔子宫内膜异位症的腹腔镜诊治 6 1 腹腔镜在子宫内膜异位症诊断中的价值 7 2 腹腔镜下子宫内膜异位症的治疗 8 参考文摘引言： 12 原创性声明（模板） 14 文章致谢（模板） 14 正文 腹腔镜诊治妊娠合并阑尾炎的临床价值 文1：腹腔镜诊治妊娠合并阑尾炎的临床价值 【Abstract】 Objective:To explore the clinical value of diagnosis and treatment for the pregnancy combined appendicitis with :The clinical data of 317 cases of pregnancy combined with appendicitis treated with laparoscopic surgery from 2003 to 2007 were analysed them,the duration of pregnancy was within three months in 187 cases,four months in 78 cases,five months in 32 cases,six months and above in 20 patients had not obvious obstetrics disease and serious cardiopulmonary :Appendectomy was performed in 317 cases of pregnancy combined appendicitis,the premature labor and abortion had not occurned,no acidosis and other complicatio were found in :Early pregnancy combined appendicitis was diagnosod and treated with laparoscopy was safe,feasible and effective,the interference to the organism and pregnancy environment was obriously less than that of the open curative effect is closely related to the size of gravid uterus and skill of the operato. 【Key words】 Pregnancy;Appendectomy;Laparoscopy 妊娠合并阑尾炎发病率为%～%［１］，是孕妇非产科情况引起腹痛的最常见原因之一。但因孕妇特殊的生理和解剖改变,其临床症状和体征常不典型,易致诊断 治疗 不及时,威胁母婴的生命安全。妊娠早、中期合并阑尾炎患者行腹腔镜阑尾切除术（laparoscopic appendectomy,LA）可获及时、有效的诊治，保障妊娠的顺利进行。2003年5月至2007年9月我院收治了317例妊娠合并阑尾炎的患者，并成功施行了LA，现将治疗结果报道如下。 1 资料与方法 临床资料 患者１８～35岁，平均26岁，妊娠3个月内187例，妊娠4个月78例，妊娠5个月32例，妊娠6个月及以上20例，孕期无其他合并症发生。 手术方法 采用腰麻或连续硬膜外麻醉，术前留置导尿。患者取仰卧位，根据妊娠月份不同选择不同穿刺点，早期妊娠选择脐缘切口Veress针盲穿建CO2气腹，压力12～14mm Hg,置入10mm Trocar，中晚期妊娠根据宫底位置在脐至剑突下选择第一Trocar位置，置入腹腔镜后在直视下于麦氏点外上方或左下腹选择做1～2个5mm切口。用无损伤钳探查腹腔，沿盲肠结肠带向下找到阑尾，提起阑尾显露盲肠壁及阑尾根部，超声刀充分游离阑尾系膜至根部，同时切断阑尾动脉，用可吸收套扎线双重结扎阑尾根部后于两结扎线间靠近阑尾远端处用超声刀切除，放入取物袋取出。放尽残气，关闭穿刺孔。 ２ 结 果 317例患者均顺利切除阑尾，其中妊娠3个月内者单纯性阑尾炎112例，化脓性阑尾炎64例，阑尾坏疽并穿孔11例；妊娠3～6个月单纯性阑尾炎88例,化脓性阑尾炎14例,阑尾坏疽穿孔8例；妊娠6个月以上单纯性阑尾炎16例，化脓性阑尾炎4例。手术时间10～28min，平均15min；术中出血1～10ml，平均2ml