坏疽化脓性阑尾炎合并穿孔的腹腔镜治疗临床医学.docVIP

坏疽化脓性阑尾炎合并穿孔的腹腔镜治疗临床医学 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：坏疽化脓性阑尾炎合并穿孔的腹腔镜治疗临床医学 1 1 资料与方法 2 2 结 果 3 3 讨 论 4 文2：化脓性阑尾炎合并穿孔的腹腔镜治疗 5 1 资料与方法 5 2 结果 6 3 讨论 6 参考文摘引言： 8 原创性声明（模板） 9 文章致谢（模板） 9 正文 坏疽化脓性阑尾炎合并穿孔的腹腔镜治疗临床医学 文1：坏疽化脓性阑尾炎合并穿孔的腹腔镜治疗临床医学 【Abstract】 Ｏbjective: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 operatio were successful and no one had mean operative time was 72min,the exhaust time was hou 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 complicatio and so on. 【Key words】 Appendicitis;Gangrene;Perforation;Appendectomy;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（或直）切口，建气腹，气腹压力为13～15mm Hg，插入10mm Trocar，直视下在左下腹合适部位置10mm Trocar，于麦氏点附近（或左、中下腹部）置5mm Trocar。首先探查，将手术床设置为头高脚低位，左侧抬高15°，以使脓液积聚于盆腔和右下腹，吸净脓液后，用大量生理盐水、甲硝唑、低分子右旋糖酐彻底清洗腹腔，吸净清洗液后，患者取头低脚高位，右侧抬高15°～30°，找到阑尾，用分离钳或超声刀分离周围粘连，显露阑尾，离断阑尾系膜至阑尾根部，阑尾动脉处凝固后切断， 或用钛夹夹闭阑尾系膜后切断，或直接用丝线结扎再离断；处理阑尾根部时，坏疽穿孔处离盲