自制阑尾把持器在腹腔镜阑尾切除术中的应用

目的探讨自制阑尾把持器在腹腔镜阑尾切除手术中的作用。方法回顾性分析2003年5月-2005年1月，我们使用自制阑尾把持器进行腹腔镜阑尾切除术（laparoscopic appendectomy．LA）145例的临床资料。其中急性单纯性阑尾炎35例，急性化脓性阑尾炎67例，坏疽穿孔性阑尾炎28例，慢性阑尾炎10例，阑尾周围脓肿5例。结果145例均获成功，无一例中转开腹。手术时间8—52min，平均36．3min。术后并发症包括5例（3．4％）术后穿刺处皮下气肿，术后1d完全吸收；2例（1．4％）trocar孔感染，经换药后痊愈。住院1—5d，平均3．6d。124例（85．5％）随访3—24个月，平均8．5月，未发现肠粘连、肠梗阻、切口疝、阑尾残端瘘等并发症。结论自制阑尾把持器在腹腔镜阑尾切除手术中手术显露好、操作方便、适应证广，值得推广。

Application of self-made manipulator in laparoscopic appendectomy

Objective To explore the application of a self-made manipulator in laparoscopic appendectomy(LA).Methods Clinical data of 145 cases of LA using a self-made manipulator from May 2003 to January 2005 were retrospectively reviewed,including 35 cases of acute simple appendicitis,67 cases of acute suppurative appendicitis,28 cases of gangrenous appendicitis,10 cases of chronic appendicitis,and 5 cases of periappendicular abscess,and were compared with clinical data of 142 cases of open appendectomy(OA) from 2001 to 2003.Results Laparoscopic appendectomy was successfully performed in all the 145 cases without conversions to open surgery.The operation time was 8~52 min(mean,36.3 min).Postoperative complications included 5 cases(3.4%) of subcutaneous emphysema at port site,which completely subsided 1 day after operation,and 2 cases(1.4%) of port-site infection,which was cured with local management.The length of hospital stay was 1~5 d(mean,3.6 d).(Follow-up) examinations in 124 cases(85.5%) for 3~24 months(mean,8.5 months) found no intestinal adhesion,intestinal obstruction,incisional hernia,or appendiceal stump fistula.Conclusions The use of self-made manipulator in laparoscopic appendectomy helps to offer well-exposed operative field,simplicity of performance,and broad surgical indications.