腹腔镜在阑尾切除术中的临床应用分析(1)
摘要：目的 研究分析腹腔镜下阑尾切除术(laparoscopic appendectomy，LA)的临床效果。方法 回顾分析江阴市第五人民医院2013年2月～2016年10月行阑尾切除术120例患者的临床资料。比较行LA与OA(open appendectomy)两种不同手术的切口长度、手术时间、住院时间、术后下床时间、术后切口感染率等指标。结果 120例患者中，80例行LA术，其中戳孔感染2例，手术时间20～40 min，平均30 min，平均住院4.5 d；40例行OA术，切口感染3例，手术时间30～60 min，平均45 min，平均住院7 d，两组手术患者均未出现肠粘连、肠梗阻及肠漏等并发症，随诊半年无异常。两种手术方式有显著的统计学差异(P<0.05)。结论 LA手术具有创伤小、手术时间短、住院时间短，术后恢复快、并发症少等优点，是治疗阑尾炎的首选方法，值得临床推广应用。
关键词：腹腔镜；阑尾炎；阑尾切除术
中图分类号：R656.8 文献标识码：A 文章编号：1006-1959(2017)17-0073-02 Clinical Analysis of Laparoscopic Surgery in Appendectomy
, http://www.100md.com
WU Tuan-jie，ZHAO Jie
(Department of General Surgery，the Fifth People's Hospital of Jiangyin City，Jiangyin 214400，Jiangsu，China)
Abstract：Objective To study the clinical effect of laparoscopic appendectomy(LA).Methods The clinical data of 120 patients undergoing appendectomy at Fifth People's Hospital of Jiangyin from February 2013 to October 2016 were analyzed retrospectively.LA and OA (open， appendectomy)were compared between two different surgical incision length，operation time，hospital stay，postoperative ambulation time，postoperative infection rate and other indicators.Results In 120 patients，80 patients underwent LA surgery，including 2 cases portsite infection，operation time was 20～40 min，average 30 min，the average length of 4.5 d；40 cases underwent OA operation，3 cases of incision infection，the operation time was 30～60 min，average 45 min，the average length of 7 d，there were no intestinal adhesion，intestinal obstruction and intestinal leakage in the two groups，and there was no abnormality in the follow-up period of 6 months.The difference between the two operative methods was statistically significant(P<0.05).Conclusion LA operation has the advantages of less trauma，shorter operation time，shorter hospitalization time，quicker postoperative recovery and less complications.It is the preferred method for treatment of appendicitis，and is worthy of clinical application.
, 百拇医药
Key words：Laparoscopy；Appendicitis；Appendectomy
急性阑尾炎作为临床上常见的一种急腹症，以转移右下腹痛、急剧发病为主要临床表现。常见的急性阑尾炎病理类型有单纯性阑尾炎、化脓性阑尾炎、穿孔性阑尾炎三种[1]。腹腔镜阑尾切除和开腹阑尾切除是临床上常用的两种手术方式[2]。目前，腹腔镜阑尾切除术是治疗急、慢性阑尾炎的有效方法[3]。本文就经腹腔镜阑尾切除术的手术方法和疗效分析，报道如下。
1 资料与方法
1.1一般资料
病例选择标准：①术前阑尾炎病史明确；②病程在8～60 h，可伴有发热；③WBC≥10×109/L，中性粒细胞比例≥80%；④或有局限性腹膜炎體征；⑤有的B超提示有右髂窝积液。排除标准：①发病时间长(>72 h)，有急性弥漫性腹膜炎；②考虑阑尾周围脓肿形成者。120例患者中，80例在腹腔镜下完成阑尾切除术(LA)，分为观察组； 40例行常规开腹阑尾切除术(OA)，分为对照组。
1.2方法
1.2.1对照组 患者在硬膜外或腰硬联合麻醉成功后术区常规消毒铺巾，取右下腹麦氏切口长约5 cm，逐层切开皮肤、肌肉、筋膜后进入腹腔内，沿着结肠带找到阑尾，断扎阑尾系膜，游离阑尾根部结扎并切除阑尾，残端荷包缝合包埋，阑尾系膜覆盖阑尾切除残端，逐层关闭腹腔，术毕。, http://www.100md.com(吴团结 赵洁)
关键词：腹腔镜；阑尾炎；阑尾切除术
中图分类号：R656.8 文献标识码：A 文章编号：1006-1959(2017)17-0073-02 Clinical Analysis of Laparoscopic Surgery in Appendectomy
, http://www.100md.com
WU Tuan-jie，ZHAO Jie
(Department of General Surgery，the Fifth People's Hospital of Jiangyin City，Jiangyin 214400，Jiangsu，China)
Abstract：Objective To study the clinical effect of laparoscopic appendectomy(LA).Methods The clinical data of 120 patients undergoing appendectomy at Fifth People's Hospital of Jiangyin from February 2013 to October 2016 were analyzed retrospectively.LA and OA (open， appendectomy)were compared between two different surgical incision length，operation time，hospital stay，postoperative ambulation time，postoperative infection rate and other indicators.Results In 120 patients，80 patients underwent LA surgery，including 2 cases portsite infection，operation time was 20～40 min，average 30 min，the average length of 4.5 d；40 cases underwent OA operation，3 cases of incision infection，the operation time was 30～60 min，average 45 min，the average length of 7 d，there were no intestinal adhesion，intestinal obstruction and intestinal leakage in the two groups，and there was no abnormality in the follow-up period of 6 months.The difference between the two operative methods was statistically significant(P<0.05).Conclusion LA operation has the advantages of less trauma，shorter operation time，shorter hospitalization time，quicker postoperative recovery and less complications.It is the preferred method for treatment of appendicitis，and is worthy of clinical application.
, 百拇医药
Key words：Laparoscopy；Appendicitis；Appendectomy
急性阑尾炎作为临床上常见的一种急腹症，以转移右下腹痛、急剧发病为主要临床表现。常见的急性阑尾炎病理类型有单纯性阑尾炎、化脓性阑尾炎、穿孔性阑尾炎三种[1]。腹腔镜阑尾切除和开腹阑尾切除是临床上常用的两种手术方式[2]。目前，腹腔镜阑尾切除术是治疗急、慢性阑尾炎的有效方法[3]。本文就经腹腔镜阑尾切除术的手术方法和疗效分析，报道如下。
1 资料与方法
1.1一般资料
病例选择标准：①术前阑尾炎病史明确；②病程在8～60 h，可伴有发热；③WBC≥10×109/L，中性粒细胞比例≥80%；④或有局限性腹膜炎體征；⑤有的B超提示有右髂窝积液。排除标准：①发病时间长(>72 h)，有急性弥漫性腹膜炎；②考虑阑尾周围脓肿形成者。120例患者中，80例在腹腔镜下完成阑尾切除术(LA)，分为观察组； 40例行常规开腹阑尾切除术(OA)，分为对照组。
1.2方法
1.2.1对照组 患者在硬膜外或腰硬联合麻醉成功后术区常规消毒铺巾，取右下腹麦氏切口长约5 cm，逐层切开皮肤、肌肉、筋膜后进入腹腔内，沿着结肠带找到阑尾，断扎阑尾系膜，游离阑尾根部结扎并切除阑尾，残端荷包缝合包埋，阑尾系膜覆盖阑尾切除残端，逐层关闭腹腔，术毕。, http://www.100md.com(吴团结 赵洁)