目的 探讨腹腔镜阑尾切除术的临床经验和应用价值。方法 回顾性分析腹腔镜二孔法阑尾切除术 39例(二孔法组)和三孔法阑尾切除术70例(三孔法组)的临床资料。结果 顺利完成手术107例； 中转开腹2例,其中阑尾严重粘连1例,腹膜后阑尾1例。术后发生粘连性肠梗阻1例,经保守治疗痊愈出院。住院时间2~9 d,平均3 d。随访全部患者2~24个月,平均12个月,未发生其他并发症。结论 腹腔镜阑尾切除术具有创伤少、并发症发生率低及恢复快的优点,将成为阑尾切除术的首选术式。腹腔镜二孔法阑尾切除术操作简单,易于推广; 三孔法则具有处理复杂阑尾切除术的优势。
目的 探讨三孔法腹腔镜胆囊阑尾联合切除术的临床价值。 方法 对64例胆囊良性病变合并急、慢性阑尾炎患者实施三孔法胆囊阑尾腹腔镜联合切除的临床资料进行分析。结果 64例均获成功，手术时间40~80 min，术后3~5 d出院，无并发症发生。结论 三孔法腹腔镜胆囊阑尾联合切除术具有创伤小、痛苦少、恢复快、住院时间短等优点，治疗胆囊阑尾良性疾病安全可靠，并可有效降低医疗费用。
的报道楔形切开浆肌层的全阑尾切除术的临床应用体会。方法对72例根部肿胀增粗、坏疽穿孔合并盲肠壁增厚的急、慢性阑尾炎，从基底部楔形切开盲肠浆肌层，进行全阑尾切除术。结果该72例中无一例发生粪瘘、残端出血、残株炎及肠粘连等并发症。 结论合理应用从基底部楔形切开盲肠浆肌层的全阑尾切除术可有效预防根部肿胀增粗、坏疽穿孔的阑尾切除术后的粪瘘、残端出血、残株炎及肠粘连等并发症。
ObjectiveTo explore the curative effect and value of laparoscopic operation in the treatment of acute gangrenous and perforated appendicitis. MethodsThe clinical data of 243 patients with acute gangrenous and perforated appendicitis from February 2011 to February 2014 in our hospital were retrospectively analyzed. Laparoscopic appendectomy was performed in 118 cases (LA group), and open appendectomy was performed in 125 cases (OA group). The operative time, hospital stay, hospital costs, incision bleeding, gastrointestinal function recovery, wound infection, pelvic abscess, and postoperative adhesions of two groups were compared. ResultsThere was no significant difference in the operative time, incision bleeding, and the incidence of pelvic abscess after operation between the LA group and OA group (P>0.05). Compared with the OA group, the recovery time of gastrointestinal function was significantly shortened (P<0.01), eating time was earlier (P<0.01), hospitalization time also shortened significantly (P<0.01), and the incidence of postoperative wound infection and intestinal adhesion were significantly decreased (P<0.01) after operation in LA group. But the cost of hospitalization in LA group increased significantly (P<0.05). ConclusionsThe laparoscopic operation in the treatment of gangrenous and perforated appendicitis are light of pain., recover quickly, shorter of hospital stay, and fewer complications. The increase of hospitalization expenses is the only deficiency.
摘要:目的: 探讨在阑尾切除术中应用抗菌薇乔缝线以减少阑尾切口感染的可能性。 方法 : 将我院2007年4月至2009年3月所有阑尾切除术病例1425例随机分为抗菌薇乔缝线组和丝线组,比较其切口感染发生率。 结果 : 统计中按阑尾未穿孔、阑尾穿孔以及总计分别计算切口感染率,在抗菌微乔线组感染率分别为017%、072%、028%,丝线组分别为154%、781%、267%,两组间分别予以X2检验,其〖WTBX〗P 值均小于001,具有显著性差异。 结论 : 缝线是辅助产生切口感染的一个危险因素,在阑尾切除术中使用抗菌薇乔缝线可以显著降低切口感染率。Abstract: Objective: To investigate the application of Coated VICRYL Plus Antibacterial suture in order to reduce the possibility of infection of appendectomy incision. Methods : Hospital from April 2007 to March 2009 appendectomy patients in all 1425 cases were randomly divided into Coated VICRYL Plus Antibacterial suture group and silk group,compared to the incidence of incision infection. Results : The statistics are not in accordance with perforated appendicitis, perforated appendicitis, as well as calculation of the total, respectively, incision infection, the infection rate in the Coated VICRYL Plus Antibacterial suture group were 017%, 072%, 028%, silk group were 154%, 781%, 267% between the two groups separately X2 test, the P value of less than 001, with a significant difference. Conclusion : The suture is to assist the incision produced a risk factor for infection in appendectomy,Coated VICRYL Plus Antibacterial suture can be used in a significant reduction in incision infection rates.
ObjectiveTo further explore and discuss the value of laparoscopic appendectomy. MethodsThe clinical data of 200 patients underwent appendectomy in this hospital from April 2009 to December 2010 were collected. The operation time, postoperative hospital stay, cost of hospitalization, postoperative anal exhaust time, postoperative pain score, and surgical complications were compared between laparoscopic appendectomy and open appendectomy. ResultsThere were 8 cases conversion to the open approach in this series. The cost of laparoscopic appendectomy was higher than that of open appendectomy (Plt;0.05); the cases of chronic appendicitis, acute simple appendicitis, acute suppurative appendicitis within 36 h of onset treated by laparoscopic appendectomy had shorter operation time, shorter postoperative hospital stay, earlier postoperative anal exhaust time, and slighter postoperative pain than those treated by open appendectomy (Plt;0.05); the differences in postoperative hospital stay, postoperative anal exhaust time, postoperative pain of acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis treated by two types of surgery had no statistical significances (Pgt;0.05); the operation time of acute gangrenous appendicitis operated by laparoscopic surgery was longer than that by open appendectomy (Plt;0.05); incision infection rate of laparoscopic appendectomy was lower than that of open appendectomy (Plt;0.05). ConclusionsFor chronic appendicitis, acute simple appendicitis, and acute suppurative appendicitis within 36 h of onset, the outcome and advantages of laparoscopic appendectomy are outstanding, the value of application is clear; and for acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis, laparoscopic appendectomy is difficult and with high rate of conversion, no obvious advantages in recovery after surgery but an increase of medical costs, and the application value is not great.
目的 探讨腹腔镜阑尾切除日间手术的优点、效果以及应用体会。方法 回顾性分析25例腹腔镜阑尾切除日间手术患者的临床资料。结果 手术时间30～80 min ,平均35 min。术后均未用止痛剂，无并发症发生，均痊愈出院。结论 腹腔镜阑尾切除日间手术是安全的，具有创伤小、恢复快、并发症少、住院时间短等优点。
ObjectiveTo compare the outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA) for the acute appendicitis patients based on our extensive experiences. MethodsThe data of all the acute appendicitis patients who underwent appendectomy from January 2013 to December 2014 in our department were retrospectively reviewed. A total of 201 patients were enrolled and divided into LA group (n=102) and OA group (n=99). The relevant clinical indexes during and after operation of two groups were compared. ResultsThere were no significant difference in age, gender, and underlying disease between LA and OA patients (P > 0.05). And the abdominal cavity infection rate, abdominal drainage rate and 30-day readmission rate were also similar (P > 0.05). But LA group had less operative time, lower infection operative wound rate, less intestinal function recovery time, shorter inhospital days and higher hospital expenses than OA group (P < 0. 05). In addition, perforated appendix and LA could increase the rate of abdominal drainage[OR=2.710, 95% CI(1.129, 6.507), P=0.026]. ConclusionsBoth LA and OA are safe and effective methods for the treatment of acute appendicitis. But LA has several advantages over OA on less operative time and postoperative complications, earlier recovery, and shorter inhospital days. While LA have higher hospital cost than OA, it still should be considered as a prefer way to cure acute appendicitis. LA is a independent risk factor of abdominal drainage.