腹腔镜阑尾切除术后预防性置管引流的再认识

目的：探讨腹腔镜阑尾切除术（1aparoscopicappendectomy，LA）后预防性置管引流的指征及位置。方法：将146例LA患者随机分为预防性置管引流组（n=71，对照组）与未预防性置管引流组（n=75，实验组），对比两组患者下床活动时间、肛门恢复排气时间、WBC恢复正常时间、腹腔残余感染率、术后炎性肠梗阻发生率及住院时间。并将预防性置管引流组患者随机分为经右中腹切口髂窝引流组（n=39，A组）与经左下腹切口盆腔引流组（n=32，B组），对比两组引流切口感染率、术后24h疼痛评分、总引流量及腹腔残余感染率。结果：实验组下床活动时间、肛门恢复排气时间、住院时间均短于对照组，差异有统计学意义（P〈0．05）；两组患者WBC恢复正常时间、腹腔残余感染率、术后炎性肠梗阻发生率差异无统计学意义（P〉0．05）。B组切1：7感染率、引流切口疼痛程度明显减轻（P〈0．05），总引流量明显多于A组（P〈0．05）；A、B两组腹腔残余感染率差异无统计学意义（P〉0．05）。结论：化脓性阑尾炎合并局限性腹膜炎、甚至弥漫性腹膜炎的患者，术中阑尾根部处理满意，腹腔冲洗干净彻底，不主张常规放置引流。如果放置引流，建议引流管经左下腹部切口放置于盆腔内。

Recognition of preventive abdominal drainage after laparoscopic appendectomy

Objective：To investigate the indication and position of preventive abdominal drainage after laparoscopic appendec- tomy （LA）. Methods：One hundred and forty-six cases of LA were randomly divided into preventive drainage group （71 cases） and non-drainage group （75 cases）. The leaving bed time, the time of anus exhaust, the recovery time of WBC, abdominal residual infection rate,the incidences of postoperative inflammatory ileus and hospital stay were compared between the two groups. 71 patients with pre- ventive drainage were randomly divided into the right iliac fossa drainage group （group A 39 cases） through right middle abdominal in- cision and the pelvic cavity drainage group （ group B 32 cases） through left lower abdominal incision. The infection rate of drainage in- cision, postoperative 24 h pain scores, total volume of drainage and abdominal residual infection rate were compared between the group A and B. Results：The leaving bed time,the time of anus exhaust and hospital stay were shorter in non-drainage patients, and the differ- ences were statistical significant （ P 〈 O. 05 ）. There was no difference in the recovery time of WBC to normal level, abdominal residual infection rate and the incidences of postoperative inflammatory ileus between the two groups （P 〉 O. 05）. The incisional infection rate and pain degree were significantly reduced in group B （ P 〈 0.05 ）. Total volume of drainage was significantly more than that of group A （P 〈 O. 05 ）. There was no difference in abdominal residual infection rate between the group A and B （ P 〉 0.05 ）. Conclusions ： The conventional drainage tube is not advocated to he placed in LA for the suppurative appendicitis with localized peritonitis even diffuse peritonitis, as long as appendix root is treated satisfactorily, abdominal cavity is cleaned thoroughly. If drainage tube should be placed,it is suggested that drainage tube be placed in pelvic cavity through the incision of left lower quadrant.