腹腔镜手术治疗妊娠早期阑尾炎的临床体会(1)
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[摘要] 目的：探讨腹腔镜手术在早期妊娠合并急性阑尾炎中的应用价值。方法：回顾分析2007年1月～2010年12月应用腹腔镜诊治46例妊娠合并急性阑尾炎患者的临床资料，其均无明显的产科疾病及严重的心肺疾病，并随机选取34例开腹手术患者作为对照组。结果：46例均顺利完成手术，无一例中转开腹，均痊愈出院，无流产、子宫损伤、腹腔脏器损伤、切口感染裂开、腹腔感染、腹腔残余脓肿形成、肠梗阻等并发症出现。研究组手术时间(38.57±19.72)min、肛门排气时间(18.31±7.25)h、抗生素使用时间(1.98±0.75)d、住院时间(5.74±1.64)d均明显短于对照组，术中出血量(89.58±12.93)ml少于对照组(185.56±54.62)ml。结论：妊娠合并急性阑尾炎行腹腔镜手术具有微创、美容、探查全面、降低阴性剖腹率，对急性阑尾炎能早期诊断、早期手术，减少阑尾穿孔的机会、减少对子宫的刺激、减少流产的机率，并发症少，缩短住院日期等优点。
[关键词] 腹腔镜手术；急性阑尾炎；妊娠
[中图分类号] R656.8[文献标识码]B [文章编号]1673-7210(2011)07(b)-233-02
Clinical experience in early pregnancy appendicitis with laparoscopic surgery
ZHANG Wenwei, CAO Tiansheng*
Southern Medical University,Guangzhou 510515, China
[Abstract] Objective: To discuss the application value of early pregnancy combined with acute appendicitis treated with laparoscope. Methods: The clinical materials of 46 cases of such patient were analyzed from January 2007 to December 2010 retro-spectively who had no other diseases. Results: The operation was completed smoothly in all the cases, no conversion to laparotony was needed. They were fully recoveed and discharged, no complications such as abortion, trauma of uterus, abdominal or ganinjury,infection and disruption of incisional wound,abdominal infection and intestinal obstruction occurred. Of operative time(38.57±19.72)min,anal exhaust time (18.31±7.25)h, antibiotics,use of time (1.98±0.75) d, length of hospital stay(5.74±1.64)d were significantlyshorter than the control group,blood loss volume (89.58±12.93) ml than the control group(185.56±54.62)ml. Conclusion: The laparoscopic surgery in early pregnancy combined with acute appendicitis is minimal invasion and beauty which can explore full-scale,reduce laparotomize rate,reduce the chance of appendiceal perforation, decrease the stimulation to womb, reduce the probability of abortion and complications and shorten hospitalization time and so on.
[Key words] Laparoscopic surgery; Acute appendicitis; Pregnancy
急性阑尾炎是妊娠期最常见的急腹症之一，发病率为0.1%～0.2%，是孕妇非产科情况引起腹痛的最常见原因之一[1]。由于妊娠所致的解剖和生理的改变，阑尾炎的临床症状和体征并不明显，如果治疗不及时，则可致孕妇和胎儿的并发症和死亡率上升，早期诊断和积极的手术治疗是提高孕妇和胎儿安全的关键。随着腹腔镜技术的发展，腹腔镜手术正逐渐替代开腹手术，经腹腔镜下行阑尾炎阑尾切除术(laparoscopic appendectomy， LA)已成为“金标准”，可获及时、有效的诊治，保障妊娠的顺利进行，有创伤小、出血少、住院时间短、腹壁美容、恢复快等优点，本研究回顾性分析笔者所在医院2007年1月～2010年12月对46例早期妊娠合并阑尾炎患者采用腹腔镜手术治疗，效果满意，现报道如下：
1 资料与方法
1.1 一般资料
选择笔者所在医院2007年1月～2010年12月收治的46例早期妊娠合并阑尾炎采用腹腔镜手术治疗的患者 ......
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