急性阑尾炎术后切口感染的预防

目的探讨综合预防急性阑尾炎手术切口感染的方法,达到减少切口感染的目的。方法对90例急性阑尾炎患者的临床资料进行回顾性分析。结果本组仅有2例出现切口感染,发生率为2.2%,取得较好的效果。结论只要能够早期诊断及处理;术前及术后及时合理使用抗生素;术中注意无菌操作,保护切口,减少污染;应用大量生理盐水及甲硝唑冲洗腹腔;正确应用引流;采用可吸收线缝合等措施,可以有效的降低阑尾切除术后的切口感染率。     

阑尾炎术后切口感染因素探讨与预防

我院于1986年1月至1995年12月，共施行阑尾切除术420例，术后发生切口感染20例，现就切口感染的可能因素分析如下。临床资料本组420例。病理类型：单纯性阑尾炎139例，化脓性阑尾炎162例．坏疽性阑尾炎119例。其中穿孔性阑尾炎56例，未穿孔364例。病程：《24小时120例，24～48小时209例，48～75小时gi例；手术时间：＜1小时347例，＞1小时73例。切除术式：顺行403例，逆行17例。腹膜缝合方法：一针缝合110例，常规缝合310例。术前、术后用甲硝哩110例，术后用甲硝哩310例。讨论一、阑尾病程病理变化与切口感染关系：发病超过24小时，随着术…     

浅谈阑尾炎手术切口感染的预防

急性阑尾炎是外科的常见多发病,居各种急腹症的首位.切口感染是阑尾炎手术的并发症之一,直接关系到手术治疗的效果.     

浅谈阑尾手术后的切口感染预防

阑尾切除术后常见的并发症为切口感染，其形成的因素是多方面的，所以减少阑尾手术后的切口感染应采取综合措施。从多方面着手，真正做到确实有效，现介绍资料如下。     

小切口预防阑尾切除术后切口感染

切口感染是阑尾切除术后最常见的并发症。根据微创原则，我院1998年3月1日至1999年3月1日采用小切口施行阑尾切除术230例。无一例发生刀口感染，现介绍如下。     

阑尾炎术后切口感染原因分析及预防

<正>急性阑尾炎是外科常见病,手术为其主要治疗方式。阑尾切除术难度不大,但术后并发症较多,以切口感染最为多见[1-2]。我院2012年5月—2014年5月行阑尾切除术600例,47例术后发生切口感染,总结报告如下。1资料与方法1.1一般资料600例患者中,男273例,女327例,年龄15~85岁,均行阑尾切除术,术后47例发生切口感染。患者的一般资料见表1。1.2方法分析患者的年龄、腹部脂肪厚度[3]、腹痛持续时     

改进腹壁切口缝合术预防阑尾切除术后切口感染

1 资料和方法阑尾切除术91例,男53例,女38例,年龄7～78岁.平均住院7.6d.急性单纯性阑尾炎27例,急性化脓性阑尾炎45例,坏疽性阑尾炎19例.其中合并阑尾穿孔者22例,腹腔内脓液最多者约300ml.91例中7例伴Ⅱ型糖尿病,1例妊娠6个月,1例合并右输卵管扭转坏死一并切除右输卵管.     

切口负压封闭引流预防阑尾炎切口感染（附16例报告）

切口感染是穿孔性阑尾炎阑尾切除术后最常见的并发症。我们采用切口负压封闭引流 (ＶＳＤ)延期缝合的方法预防切口感染 ,疗效满意。报告如下。1　临床资料全组 16例 ,男 6例 ,女 10例。年龄 19～ 71岁。手术及病理检查证实为穿孔性阑尾炎。病人均合并有弥漫性腹膜炎 ,术中切口污染重。处理方法 :切除阑尾、清洁腹腔后 ,用可吸收线连续缝合腹膜 ,用 4号丝线间断一次缝合皮肤、皮下及腹外斜肌腱膜或腹直肌前鞘 ,不打结。然后裁剪医用泡沫材料 ,与切口等长同深 ,厚 0 9ｃｍ。置入切口 ,将切口边缘靠拢对齐 ,用生物透性薄膜粘贴封闭 ,行ＶＳＤ[…     

化脓性阑尾炎手术切口感染的预防

目的 探讨化脓性阑尾炎手术切口感染的预防措施.方法 回顾性分析采用预防性应用抗生素,腹膜外翻,全层缝合等措施处理的320例化脓性阑尾炎患者临床资料.结果 320例患者317例术后8～10 d拆线,切口Ⅰ期愈合,3例(0.9%)切口感染.结论 预防性合理应用抗生素,腹膜外翻护皮,全层缝合等措施可以明显降低化脓性阑尾炎手术...     

阑尾手术切口感染的预防(附1300例分析)

探讨阑尾手术预防切口感染的方法。1975～1994年手术治疗阑尾炎1300例，分为3组：1975～1983年511例为第1组；1984～1993年的789例随机选550例为第2组；余下的为第3组。第1组切口一期缝合，术后静脉滴注抗生素7～9天；第2组切口一期缝合，术前、术中、术后大量抗生素静滴4～7天；第3组根据不同情况分别采用腹膜切口中心缝合1针，或腹膜二期缝合等方法。第2、3组采用腹膜外翻法，并反复冲洗。结果：第1组感染率21．23％，第2组8．72％，第3组1．67％。提出过分强调传统的一期闭合切口的原则应予修正，部分缝合切口腹膜的方法，同样能达到预防阑尾切口感染的目的。     

腹腔、腹壁肌和皮肤三个层面冲洗在预防阑尾切口感染中的应用及疗效比较

目的 评价术中冲洗在预防阑尾切口感染的作用。方法 600例穿孔性阑尾炎随机分成三组。腹腔冲洗组189例（A组）、腹腔、腹壁肌冲洗组202例（B组）、腹腔、腹壁肌和皮肤三个层面冲洗组209／N（cN），冲洗均用生理盐水及甲硝唑。术后观察三组切口感染情况。结果 切口感染率A组为18．52％（35／189），BN为7．43％（15／202），C组为3．35％（7／209），三组差异有显著性（P〈0．05）。结论 腹腔、腹壁肌和皮肤三个层面清洁能显著降低阑尾切口感染率。     

急性阑尾炎行腹腔镜手术与开腹手术的比较

目的对比分析腹腔镜与开腹阑尾切除术在治疗急性阑尾炎中的手术效果。方法回顾性分析2009年1月至2011年10月58例行腹腔镜阑尾切除术（LA组）和同期55例行开腹阑尾切除术（OA组）的急性阑尾炎患者的临床资料,比较两种术式手术时间、下床活动时间、术后排气时间、止痛药物使用率、并发症发生率、住院时间及综合费用等指标。结果 LA组与OA组相比上述指标除手术时间外差异均有统计学意义（P〈0.05）。结论腹腔镜阑尾切除术治疗急性阑尾炎具有创伤小、恢复快、并发症少和住院时间短等优点,可作为治疗急性阑尾炎的理想选择。     

儿童白血病并发急性阑尾炎的治疗分析(附13例报告)

目的探讨儿童急性白血病并发急性阑尾炎的治疗方法及手术时机。方法回顾分析我院1990年1月至2008年1月治疗的13例儿童急性自血病并发急性阑尾炎患者的临床资料。结果13例患者中,急诊手术4例,择期手术7例,保守治疗2例。本组死亡1例,治愈10例,非手术治愈2例。结论白血病儿童并发急性阑尾炎,多应手术治疗,若无穿孔、弥漫性腹膜炎、肠梗阻等紧急情况,首选择期手术。患儿手术危险性较高．故围手术期应采用积极措施。     

腹腔镜手术治疗急性阑尾炎并穿孔256例报告

目的:探讨腹腔镜阑尾切除术治疗急性阑尾炎并穿孔的手术方法、指征、并发症及效果.方法:回顾分析2006年7月至2010年6月为256例急性阑尾炎并穿孔患者行腹腔镜手术的临床资料.结果:256例手术均获成功,无一例中转开腹.手术时间35～110 min,平均55 min,术中出血量5～20 ml,术后排气时间平均19.5 ...     

急性化脓性阑尾炎切口感染的危险因素分析及预防对策

目的：分析急性化脓性阑尾炎患者术后切口感染的危险因素,探讨有效的预防对策。方法回顾性分析我院2011年1月～2014年2月间收治的219例急性化脓性阑尾炎患者的临床资料,观察术后切口感染情况,对术后切口感染的危险因素进行分析,总结预防经验。结果本组219例急性化脓性阑尾炎患者,术后切口感染16例,切口感染率为7.3%。经对症处理后,切口达到Ⅱ期愈合。切口感染率在不同年龄、合并基础疾病、术前应用抗生素以及手术时间方面的差异有统计学意义（P＜0.05）,而不同性别、切口长度及术后抗生素应用时间方面的差异无统计学意义（P＞0.05）。结论高龄、合并有基础疾病、术前未应用抗生素以及手术时间过长是急性化脓性阑尾炎术后切口感染的危险因素,术前合理应用抗生素,术中合理操作,缩短手术时间,术后加强观察是预防切口感染的关键。     

Impact of previous abdominal surgery on laparoscopic appendectomy for acute appendicitis

Background Laparoscopic appendectomy is one of the most commonly performed laparoscopic procedures. Impact of previous abdominal surgery on laparoscopic appendectomy has not been previously reported. Methods From January 2001 to December 2005, 2029 patients with clinically suspected acute appendicitis underwent laparoscopic surgery in our hospital. Of these, 234 patients (11.5%) were found to have other pathology by intraoperative or histologic findings and were excluded from the study. The 1795 patients who underwent laparoscopic appendectomy for acute appendicitis were divided into three groups: group 1, patients without a history of previous abdominal surgery (n = 1652, 92%); group 2, patients with a history of upper abdominal surgery (n = 20, 1.1%); group 3, patients with a history of lower abdominal surgery (n = 123, 6.8%). Data were collected retrospectively by chart review and analyzed for conversion rate, operative time, intraoperative and postoperative complications, and hospital stay. Results Of the 1795 patients, 13 (0.7%) were converted to open appendectomy because of technical difficulty. Overall mean operative time was 57.2 (range, 20–225) min. There was no mortality or intraoperative complications. Overall postoperative complication rate was 10.7% (n = 193): rate of surgical wound infection was 8.2 % (n = 147), surgical wound seroma 1.3% (n = 24), and intra-abdominal abscess 0.8% (n = 14). Overall postoperative hospital stay averaged 3.2 (range, 0–39) days. There were no significant differences between the three groups regarding the conversion rate (0.8% vs. 0% vs. 0%, p = 0.567), operative time (57.3 vs. 55.8 vs. 56.9 min, p = 0.962), postoperative complication rates (10.7 vs. 10 vs. 12.2%, p = 0.863), and hospital stay (3.2 vs. 3.6 vs. 3.1 days, p = 0.673). Conclusions Previous abdominal surgery, whether upper or lower abdominal, has no significant impact on laparoscopic appendectomy for acute appendicitis.     

Laparoscopic versus open appendectomy in acute appendicitis: A randomized prospective study

Background: Laparoscopic appendectomy is a safe and effective procedure, as both a diagnostic and therapeutic tool. It seems to be more effective than the corresponding open procedure. Aim of this study is to evaluate a group of patients randomly allocated either to laparoscopic appendectomy (LA) or to open appendectomy (OA). Methods: From January 1998 to December 2002, 252 consecutive and nonselected patients, 155 women and 97 men, were randomized either to LA or OA. Recorded data were operative time, postoperative length, of stay and complications. Results: Mean operative time was 45 min (range 30–120) for OA and 36 min (25–60) for LA, mean postoperative stay was 5.5 days (4–12) for OA and 3.4 days (2–8) for LA. Complication occurred in 20 patients (14.5%) for OA and in four patients (2.6%) for LA. Conclusion: We believe that LA is effective in any kind of clinical situation, with low traumatic impact and best comfort for the patient.     

Laparoscopic appendectomy for complicated appendicitis: an evaluation of postoperative factors

Background The use of laparoscopic appendectomy for complicated appendicitis is controversial. Outcomes were compared between patients who had complicated appendicitis and those who had uncomplicated appendicitisMethods Consecutive patients (n = 304) who underwent laparoscopic appendectomy were studied. Patients undergoing open appendectomies also were compared ad hoc. Analgesia use, length of hospital stay, return to activity, and complication rates for the complicated and uncomplicated appendicitis subgroups were analyzed.Results Complete data were available for 243 patients (80%). There were no statistical differences in characteristics between the two groups. The operating times, lengths of hospital stay, return to activity times, complication rates, and analgesia requirements, both in the hospital and after discharge, were equivalent. A greater number of complicated cases required open conversion. Considering those with complicated appendicitis, the open group had a significantly longer mean hospital stay and a higher complication rate than those treated with laparoscopic appendectomy.Conclusions The minimally invasive laparoscopic technique is safe and efficacious. It should be the initial procedure of choice for most cases of complicated appendicitis.Presented at the Canadian Association of General Surgeons meeting in Vancouver, British Columbia, Canada, 18 September 2003     

腹腔镜阑尾切除术治疗腹部手术史急性阑尾炎的临床研究

目的探讨腹腔镜阑尾切除术治疗腹部手术史急性阑尾炎的的可行性及临床疗效。方法回顾性分析2009年2月-2012年6月行腹腔镜手术治疗的253例急性阑尾炎患者的临床资料,其中无腹部手术史患者177例（无手术史组）,腹部手术史患者76例（手术史组）,比较两组患者的中转开腹率、手术时间、术中失血量、肠功能恢复时间、并发症发生率、术后住院时间。结果无手术史组和手术史组的中转开腹率分别是1．7％和1．3％（P〉0．05）,手术时间分别是（40．5±12．3）min和（62．6±14．2）min（P〈0．05）。两组的术中失血量、肠功能恢复时间、术后并发症发生率及术后住院时间的差异均无统计学意义（P〉0．05）。结论腹部手术史使腹腔镜阑尾切除术的手术时间延长,但对手术疗效无明显影响,提示腹腔镜手术治疗腹部手术史急性阑尾炎安全、有效,且仍具有创伤小、恢复快的优势。     

Dengue fever mimicking acute appendicitis: A case report

INTRODUCTIONDengue fever is an acute viral disease, which usually presents as a mild febrile illness. Patients with severe disease present with dengue haemorrhagic fever or dengue toxic shock syndrome. Rarely, it presents with abdominal symptoms mimicking acute appendicitis. We present a case of a male patient presenting with right iliac fossa pain and suspected acute appendicitis that was later diagnosed with dengue fever following a negative appendicectomy.PRESENTATION OF CASEA 13-year old male patient presented with fever, localized right-sided abdominal pain and vomiting. Abdominal ultrasound was not helpful and appendicectomy was performed due to worsening abdominal signs and an elevated temperature. A normal appendix with enlarged mesenteric nodes was found at surgery. Complete blood count showed thrombocytopenia with leucopenia. Dengue fever was now suspected and confirmed by IgM enzyme-linked immunosorbent assay against dengue virus.DISCUSSIONThis unusual presentation of dengue fever mimicking acute appendicitis should be suspected during viral outbreaks and in patients with atypical symptoms and cytopenias on blood evaluation in order to prevent unnecessary surgery.CONCLUSIONThis case highlights the occurrence of abdominal symptoms and complications that may accompany dengue fever. Early recognition of dengue fever mimicking acute appendicitis will avoid non-therapeutic operation and the diagnosis may be aided by blood investigations indicating a leucopenia, which is uncommon in patients with suppurative acute appendicitis.