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Several Problems During The Experience of Laparoscopic Appendectomy (Report of 132 Cases)

目的 总结腹腔镜阑尾切除术（laparoscopic appendectomy,LA）治疗阑尾炎的经验。方法 回顾性分析1999年8月至2006年8月我院行LA治疗的132例阑尾炎患者的临床资料，其中慢性阑尾炎急性发作19例，急性单纯性阑尾炎15例，急性化脓性阑尾炎93例，阑尾穿孔腹膜炎5例。结果 2例中转开腹。130例成功完成LA，手术时间22~55 min，平均30.5 min； 术中出血量2~10 ml； 住院2~12 d，平均3.4 d。术后出现早期炎性肠梗阻1例，经非手术治疗治愈。结论 LA操作简便可行，操作得当可在基层医院推广。

Effect of Povidone Iodine for Preventing The Surgical Site Infections in Class Ⅲ Appendectomy Incision

目的探讨碘伏原液浸泡对于预防阑尾Ⅲ类手术切口手术部位感染（SSI）的疗效。 方法回顾性分析笔者所在医院2012年5月至2013年5月期间施行阑尾切除术者中切口类型为Ⅲ类的92例患者的临床资料，比较以碘伏原液浸泡切口（浸泡组）和冲洗切口（常规组）处理后患者的切口愈合情况。 结果术后常规组57例患者中，有43例切口愈合等级为甲级，5例为乙级，9例为丙级，SSI发生率为24.56%（14/57）。浸泡组35例患者的切口愈合均良好，均为甲级愈合，SSI发生率为0，低于常规组（P<0.05）。 结论采用碘伏原液浸泡切口5 min能有效预防阑尾炎Ⅲ类切口SSI的发生，值得临床推广应用。

Further Exploring and Discussing Clinical Value of Laparoscopic Appendectomy

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.

应用彩色超声定位辅助异位阑尾切除术

【摘要】目的 总结应用彩色超声辅助定位在异位阑尾切除术中的作用。方法 2005年4月-2009年8月行阑尾切除术380例,男223例,女157例；年龄10~71岁。根据术前是否行彩色超声定位分为实验组和对照组(n=190),分别施行彩色超声定位改良小切口阑尾切除术和传统切口阑尾切除术。术中共发现异位阑尾40例,分析异位阑尾切除术的术中及术后情况。结果 实验组手术时间、术中是否延长切口、术后切口感染率、住院时间等均明显优于对照组。结论 彩色超声在异位阑尾切除术中有很重要的临床意义。

急性阑尾炎的高频超声表现

目的:探讨高频超声对阑尾炎分型诊断的应用价值及临床指导意义。方法:回顾性分析2008年1～3月在华西医院行手术治疗的60例各型阑尾炎(包括急性单纯性阑尾炎、急性化脓性阑尾炎、坏疽及穿孔性阑尾炎、阑尾周围脓肿)的高频超声声像图特征。结果:高频超声根据60例各型阑尾炎, 在各个发病阶段显示阑尾的声像图特征分型诊断单纯性阑尾炎8例,急性化脓性阑尾炎40例,急性坏疽性阑尾炎8例,阑尾周围脓肿4例。结论:高频超声在急性阑尾炎分型诊断中具有重要的实用价值,并能对临床诊断起到重要的参考作用。

阑尾黏膜防御素5 mRNA的表达及意义

Laparoscopic Appendectomy by Concealed Three Ports Technique (Report of 192 Cases）

目的　 探讨隐蔽三孔法腹腔镜阑尾切除术的应用。方法　患者取头低左侧卧位。在脐缘切口插入10 mm的套管，放入腹腔镜。在腹腔镜监视下分别于耻骨结节左、右侧阴毛生长区作10 mm、5 mm切口，两切口相距8~10 cm。术者通过耻骨上途径完成阑尾切除操作。结果　192例痊愈出院，无一例手术中转，平均手术时间（25±4.32） min，平均住院时间（5±0.79） d。切口甲级愈合，基本不留疤痕。无手术并发症发生。结论　隐蔽三孔法腹腔镜阑尾切除术具有美容效果好、创伤小、并发症少等优点。

妊娠阑尾炎的诊治体会

目的探讨妊娠阑尾炎的诊断与最佳手术时间。 方法回顾性分析2011年10月至2015年10月期间我院诊治的50例妊娠阑尾炎患者的临床资料。根据发病后至手术时间分为观察组和对照组，观察组为发病时间24 h内进行手术者，对照组为发病时间超过24 h进行手术者。比较2组患者的平均住院时间、早产率、切口感染率和术中引流管放置率。 结果2组患者的年龄、孕周、血白细胞计数及体温比较差异均无统计学意义（P＞0.05），观察组急性蜂窝织性阑尾炎患者所占比例明显高于对照组（χ2=9.93，P=0.002），而对照组急性坏疽性阑尾炎患者所占比例明显高于观察组（χ2=9.93，P=0.002）。观察组的住院时间明显短于对照组（t=2.36，P=0.02），早产率、切口感染率及术中引流管放置率均明显低于对照组（χ2=5.56，P=0.018；χ2=5.35，P=0.021；χ2=8.42，P=0.004）。 结论妊娠阑尾炎强调早期诊断和及早手术治疗，发病时间24 h内进行手术治疗效果较好。

Clinical analysis of left-sided appendicitis: report of 2 cases and review of 212 published cases

Objective To investigate the clinical features, diagnosis, and surgical methods of left-sided appendicitis (LSA). Methods We retrieved LSA-related literatures through Pubmed, Google Scholar English databases, Wanfang, CNKI, VIP, and SinoMed databases (published from January 1981 to June 2017), as well as 2 cases of LSA who treated in Beibei Traditional Chinese Medical Hospital, to analyze the clinical characteristics of LSA and its diagnosis and treatment methods. Results There were 92 articles in a total of 212 LSA patients were retrieved, and 2 cases treated in Beibei Traditional Chinese Medical Hospital, a total of 214 LSA patients were included in the analysis. Pain fixed position of LSA: 139 cases (65.0%) located in left-lower quadrant, 30 cases (14.0%) located in right-lower quadrant, 8 cases (3.7%) located in peri-umbilical, 15 cases (7.0%) located in mid-lower abdomen, 15 cases (7.0%) located in left-upper quadrant, 3 cases (1.4%) located in right-upper abdomen, 2 cases (0.9%) located in mid-upper abdomen, 2 cases (0.9%) located in pelvic cavity, respectively. LSA had occurred in association with several types of abnormal anomalies: 131 cases (61.2%) suffered from situs inversus totalis (SIT), 53 cases (24.8%) suffered from midgut malrotation (MM), 21 cases (9.8%) suffered from cecal malrotation, 4 cases (1.9%) suffered from long appendix, 2 cases (0.9%) suffered from free ascending colon, and 3 cases (1.4%) were unclear. The diagnosis of 114 LSA cases (53.3%) before operation was correct, in which the correct diagnosis rates of SIT-LSA and MM-LSA were 74.8% (98/131) and 22.6% (12/53), respectively. Three patients (1.4%) underwent conservative treatment, and 211 patients (98.6%) underwent surgical treatment, including 25 cases (11.7%) of laparoscopic surgery, 145 cases (67.8%) of open abdominal surgery, and unknown of 41 cases (19.1%). Laparotomy incision: abdominal incision in 74 cases (51.0%), ventral midline incision in 16 cases (11.0%), the left side of the anti McBurney incision in 43 cases (29.7%), right McBurney incision in 12 cases (8.3%). Conclusions LSA mainly occurs in association with 2 types of congenital anomalies: SIT and MM. There is some difficult to make diagnosis for abnormal anatomy and inaccurate pain location of LSA, so it is easy to cause the delay in diagnosis or misdiagnosis. For LSA, the choices of laparoscopy or laparotomy operation methods are applicable.

阑尾切除术后医源性肠外瘘6例报告