腹腔镜阑尾切除术238例临床分析

目的:探讨腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的临床应用价值。方法:回顾分析1993年1月至2009年12月为238例患者施行腹腔镜阑尾切除术的临床资料。结果:235例成功完成LA,3例中转开腹,手术时间15～80min,平均(56.25±10.20)min;术中出血5～50ml,平均(10.3±8.5)ml;术后应用抗生素时间平均(3.1±1.4)d;术后住院2～8d,平均3.5d。随访173例(72.7%),随访时间3～130个月,平均52个月,除1例切口脂肪液化感染外,未发生肠漏、残株炎、腹腔脓肿、粘连性肠梗阻、切口疝等手术并发症。结论:LA治疗阑尾炎安全、有效,具有患者创伤小、痛苦轻、术后住院时间短、康复快、美容效果好、并发症少等特点,另外,能同时诊断和治疗腹腔内其他疾病,特别适于多种腹腔疾病联合手术者,以及肥胖、诊断不明确、异位阑尾患者及育龄期妇女。

Clinical analysis of laparoscopic appendectomy:a report of 238 cases

Objective:To study the clinical application value of laparoscopic appendectomy (LA).Methods:The clinical data of 238 patients performed LA from Jan.1993 to Dec.2009 were analyzed retrospectively.Results:The procedure was successfully accomplished in 235 cases,while 3 cases were converted to laparotomy.The operating time was 15-80min,mean (56.2±10.20)min.The blood lost was 5-50ml,mean (10.3±8.5)ml.The mean periods of antibiotic use were (3.1±1.4)d.The postoperative hospital stay was 2-8d,mean 3.5d.Follow-up data were available for 173 patients (72.7%) from 3 to 130 months,mean 52 months.One case occurred incisional fat liquefaction and infection,no intestinal fistula,residual appendicitis,intra-abdominal abscess,adhesive intestinal obstruction,or incisional hernia were found during follow up time.Conclusions:LA is safe and effective for appendicitis,with advantages such as more minimal trauma,less suffering,faster recovery,shorter hospital stay,better cosmesis and less complications.Besides,it can be beneficial to some special patients such as obese,suspected diagnosed,ectopic appendix,child-bearing period woman and patients,who require combined laparoscopic procedures for other diseases.